Reducing hospital admissions of healthy children with functional constipation: a quality initiative

Abstract

Functional constipation (FC) is a common medical problem in children, with minimal risk of long-term complications. We determined that a large number of children were being admitted to our children’s hospital for FC in which there was no neurological or anatomical cause. Our hospital experienced a patient complication in which a patient died after inpatient treatment of FC. Subsequently, we developed a standardised approach to determine when paediatric patients needed hospitalisation for FC, as well as to develop a regimented outpatient therapeutic approach for such children to prevent hospitalisation. Our quality improvement initiative resulted in a large decrease in the number of children with FC admitted into the hospital as well as a decrease in the number of children needing faecal disimpaction in the operating room. Our quality improvement process can be used to decrease hospitalisations, decrease healthcare costs and improve patient care for paediatric FC.

Multidisciplinary Care for Refractory Pediatric Functional Abdominal Pain Decreases Emergency and Inpatient Utilization

“…gov/data/hcup/index.html). Decreasing hospital admissions of children with other functional disorders, such as constipation, have been shown to be an objective quality indicator (20). Future prospective and longitudinal studies evaluating quality indicators for longer than one year are needed to determine to determine the long-term success of multidisciplinary care for childhood FAP.…”

“…New in this study is the effect of multidisciplinary care for children with FAP in decreasing both ED and inpatient admissions, which are key components of the Healthcare Cost and Utilization Project by the Agency for Healthcare Research and Quality ( https://www.ahrq.gov/data/hcup/index.html ). Decreasing hospital admissions of children with other functional disorders, such as constipation, have been shown to be an objective quality indicator (20). Future prospective and longitudinal studies evaluating quality indicators for longer than one year are needed to determine to determine the long-term success of multidisciplinary care for childhood FAP.…”

Things We Do for No Reason™: Routinely hospitalizing children with fecal impaction for inpatient cleanouts

“…Instead, institutional culture drives practice, with clinicians relying on a wide assortment of findings from a patient's history and initial evaluation when deciding whether to hospitalize a child. Common reasons for hospitalization include 4 : automatic hospitalization of children previously hospitalized for a cleanout; fearing that fecal impaction connotes bowel obstruction or is a “red flag” for underlying pathology; determining the impaction is too large to pass using outpatient treatment; believing that patients and families cannot tolerate or successfully complete a home cleanout; concern that home cleanouts are high‐risk due to the potential for bowel perforation or electrolyte abnormalities.…”

“…3,14 The use of nasogastric tubes to administer enteral laxatives in the hospital introduces additional risk from tube misplacement or radiation exposure to confirm placement. Furthermore, one study found that patients admitted with fecal impaction "frequently" (not quantified) underwent disimpaction in the operating room despite displaying no signs of bowel obstruction, 4 an extreme manifestation of overtreatment.…”

Evaluation of Rheography of the Colon in Idiopathic Megarectosigmoidi in Children

“…В последние годы многие исследователи уделяют большое внимание кишечному кровотоку, так как от его состояния зависит течение воспалительных процессов и заживление анастомозов после реконструктивных операций на кишечнике. Однако, как говорилось выше, все исследования по определению гемодинамики кишечника в основном проводились в опытах на животных или интраоперационно [13][14][15]. Среди применяемых для этой цели методов исследования следует выделить реографию, которая широко используется для исследования упруго-вязких свойств артериальных сосудов, что дает возможность судить о ходе гемодинамических процессов как в исследуемых органах, так и в целом по регионарному и центральному звеньям кровообращения.…”