Several of our members are involved in exciting and important research and Quality Improvement (QI) work for our field. Some of you may be participating in the SPUC sponsored QI project on reducing abdominal x-rays in the diagnosis and management of constipation in the urgent care setting. SPUC members Dr. Ben Klick from Children’s Hospital of the King’s Daughters and Dr. Rachel Lucas from Children’s Wisconsin are spearheading this project; here is the background and overview of the project.
Background and rationale
Functional constipation is extremely common in children. Diagnosis of constipation as a cause of abdominal pain should be based on history and physical exam. Abdominal x-rays have been shown to have limited value in the diagnosis of children with constipation and are not recommended to diagnosis constipation. Despite this, up to 70% of pediatric patients diagnosed with constipation still receive an abdominal x-ray. These mostly unneeded x-rays increase healthcare costs, expose patients to harmful radiation and increase total length of stay. Multiple single center quality improvement (QI) projects have taken place in pediatric emergency departments to address this issue.
However, there have been no similar published reports of similar in pediatric urgent care centers and in particular no multicenter pediatric urgent care projects. SPUC has successfully led multi-center QI projects in the past, focused on antibiotic stewardship, and was therefore a natural choice to host a new multicenter QI project focusing on increasing the use abdominal x-rays used to diagnosis constipation.
Project overview
This project will run from 2/1/25-10/31/2025. The first three months will involve collection of baseline data and then two PDSA cycles will occur. Each participating center will design its own interventions, with input from project leadership. Each participant provider will be expected to review 10 charts of patients with constipation or abdominal pain that they saw in each month. There will be monthly Zoom conferences, some of which will be interactive lectures focused on QI methodology or the diagnosis and treatment of constipation and others will be focused on questions related to project itself.
The outcome measures will be decreased cost of care and decreased use of abdominal x-rays. Whether x-rays were ordered for an appropriate reason will be tracked as a process measure. Participating providers will also review multiple clinical scenarios at the beginning and end of the project and rate how likely they would be to order an x-ray in such a scenario as a second process measure. Total length of stay and 48-hour return will be tracked as balancing measures.
The project has been approved as non-research by the Eastern Virginia Medical School IRB and ABP MOC part 4 credit will be awarded to all participating physicians through Children’s Hospital of The King’s Daughters. Over 40 providers from 10 different centers have joined the project. The first monthly webinar occurred in February, and a project key driver diagram was created at that time.
