Intussusception Protocol Implementation: Single-Site Outcomes With Clinician and Family Satisfaction.

BACKGROUND: The objective of this study was to evaluate clinical outcomes, costs, and clinician and parent satisfaction after implementation of a protocol to discharge patients from the emergency department (ED) after successful reduction of uncomplicated ileocolic intussusception. MATERIALS AND METHODS: In March 2017, an intussusception management protocol was implemented for children presenting with ultrasound findings of ileocolic intussusception. Those meeting inclusion criteria were observed after successful radiological reduction in the ED and discharged after 6 h with resolution of symptoms. Retrospective chart review was completed for cases before and after protocol implementation for clinical outcomes and costs. Clinicians and parents were surveyed to assess overall satisfaction. RESULTS: Charts were reviewed before (42 encounters, 37 patients) and after (30 encounters, 23 patients) protocol implementation. After implementation, admission rates decreased from 95% (40/42) to 23% (7/30; P < 0.001) and antibiotic use was eliminated (91% to 0%, P < 0.001). There was no difference in recurrence rates (17% versus 23%, P = 0.44). Median total length of stay decreased from 18.87 to 9.52 h (P < 0.001), whereas median ED length of stay increased from 4.37 to 9.87 h (P < 0.001). In addition, there was an overall hospital cost saving of over $2000 ($9595 ± 3424 to $7465 ± 3723; P = 0.009) per encounter. Clinicians and parents were overall satisfied with the protocol and parents showed no changes in patient satisfaction with protocol implementation. CONCLUSIONS: An intussusception protocol can facilitate early discharge from the ED and improve patient care without increased risk of recurrence. Additional benefits include decreased hospital- and patient-related costs, elimination of antibiotic use, and parent as well as clinician satisfaction.

Milk and molasses enemas: clearing things up.

INTRODUCTION: We aimed to describe current nursing practice and clarify the safest and most effective dose of milk and molasses enemas used to relieve constipation in pediatric patients presenting to a suburban pediatric emergency department. METHODS: We surveyed emergency nurses about current practice in administration of milk and molasses enemas. In addition, we identified consecutive patients aged 2 to 17 years with a discharge diagnosis of constipation or abdominal pain between 2009 and 2012. Stable patients were included from the emergency department, in the absence of chronic medical conditions. For each patient, we recorded demographic characteristics, chief complaint, nursing administration technique, stool output, patient tolerance, side effects, amount of enema given, and patient disposition. RESULTS: We identified 500 patients with abdominal pain or constipation, 87 of whom were later excluded. Milk and molasses enemas were found to be effective at relieving constipation in our population, with a success rate averaging 88% in patients given 5 to 6 mL/kg with an institutional guideline maximum of 135 mL. The success rate was found to vary with age, along with the amount of enema given. DISCUSSION: Our nursing survey showed that varying practice exists regarding technique and dosing of milk and molasses enemas. Historical chart review showed that milk and molasses enemas in our emergency department were safe and effective with minimal side effects.