A Multidisciplinary Approach to the Management of Intussusception

General Information

Institution Name: Orlando Health

Author Name and Title: Emily Ulloa, PA-C, MSPAS, Aaron Seims, MD

Name of Case Study: A Multidisciplinary Approach to the Management of Intussusception

Identification of Local Problem

Surgeons at a Level 1 ACS CSV hospital historically directed the care of intussusception, including overnight hospitalization after air contrast reduction. The problems identified were cost both to the patients and hospital, overutilization of resources, and general quality of patient care with prolonged or unnecessary time in the hospital. 

Context of the QI Activity

The team sought to standardize the management approach of intussusception by creating a multidisciplinary, evidence-based algorithm involving radiology, emergency medicine, and pediatric surgery. 

What were the interventions?

An algorithm was developed to standardize the approach, guide the emergency department team in diagnostic studies to be obtained, timing of surgical consultation (after failure to reduce via air contrast enema), safe observation in the ED after successful reduction, and when appropriate, to discharge home versus consider admission to the surgical service or operative intervention. 

Cost and Funding Sources

There were no associated costs in this QI project or funding sources needed. The data collection was performed by the surgical PA.

Overall Results and Analysis

Implementation of an intussusception pathway decreased unnecessary admission from 97% (pre-QI) to 41% (post-QI) (p < 0.005), without an increase in recurrence rate or need for surgical intervention. Discharge from the emergency department after successful air contrast reduction and a standardized observation period is a safe and effective way to manage intussusception.

Limitations

Retrospective review of outcomes rather than a randomized controlled prospective study.

Consider evaluating patient satisfaction through survey or other method as this was not measurable in retrospective review.

Lessons Learned

Education of emergency medicine team is important for algorithm adherence, especially with regard to notifying the surgical team of the patient after discharge (34% fall-out –surgical team not notified of discharge).

A multidisciplinary approach reduces unnecessary costs, improves utilization of resources, and continues quality patient care.