I like this article – not because of any specific quality improvement reason relating to their intervention, but because it reminded me of something of which I perform too many.
It’s an easy trap to fall into, the – “well, let’s just see how much poop is in there” for diagnostic reassurance and to help persuade the family you’re doing relevant testing in the Emergency Department. However, here are the relevant passages from their introduction:
In a 2014 clinical guideline, the North American and European Societies of Pediatric Gastroenterology, Hepatology, and Nutrition found that the evidence supports not performing an AXR to diagnose functional constipation.
Recent studies showed that AXRs performed in the ED for constipation resulted in increased return visits to the ED for the same problem.
I feel some solace in knowing that 50 to 70% of ED visits for constipation may include an abdominal radiograph as part of their workflow – meaning I’m just, at least, part of the herd.
So, regardless of the point of their article – that a plan-do-act cycle of education and provider feedback successfully cut their rate of radiography from 60% to 20% – this is yet another misleading and/or unnecessary test to delete from our practice routine.
“Reducing Unnecessary Imaging for Patients With Constipation in the Pediatric Emergency Department.”