Evidence-based Standardization of Constipation Management in the Emergency Department: A Quality Improvement Study.

Pediatric Quality & Safety
Matthew J LipshawEileen Murtagh Kurowski


Constipation is a common problem in pediatric patients. Abdominal radiographs (AXRs) are frequently obtained in the pediatric emergency department for diagnosis despite their poor reliability to rule out underlying pathology or prognostic ability to determine the degree of constipation. The goal of this quality improvement (QI) initiative was to standardize the diagnosis and management of constipation in the pediatric emergency department and urgent care in patients ages 6 months to 21 years and decrease AXR use by 20% and sustain this reduction for 12 months. This prospective QI project involved a multidisciplinary team at a large urban pediatric tertiary care center. The study team constructed a key driver diagram and identified interventions, such as creating a standardized evaluation and management algorithm for constipation, using free open-access medical education platforms, incorporating the electronic medical record interface, and expanding educational conferences to include standardized approach and discharge instructions for patients with constipation across all acuity levels. The primary measure of AXR utilization was tracked overtime on a statistical process control chart to evaluate the impact of interventions. The...Continue Reading


Dec 1, 1992·Annals of Emergency Medicine·S G RothrockC B Hummel
Mar 12, 2004·The Medical Journal of Australia·Robert W Sanson-Fisher
Jul 2, 2005·Journal of Pediatric Gastroenterology and Nutrition·Nader N YoussefJoel R Rosh
Jul 6, 2005·Archives of Pediatrics & Adolescent Medicine·Lieke M Reuchlin-VroklageMarjolein Y Berger
Oct 5, 2010·Journal of Pediatric Gastroenterology and Nutrition·Rok Seon ChoungNicholas J Talley
Mar 9, 2011·Best Practice & Research. Clinical Gastroenterology·Suzanne M MugieCarlo Di Lorenzo
Oct 17, 2013·The Journal of Pediatrics·Stephen B FreedmanSuzanne Schuh
Dec 19, 2013·Journal of Pediatric Gastroenterology and Nutrition·M M TabbersM A Benninga
Jul 15, 2015·The Journal of Pediatrics·Jacob KurowskiLee M Bass
May 4, 2017·The American Journal of Emergency Medicine·Corrie E ChumpitaziBruno P Chumpitazi
Nov 7, 2019·Nature Reviews. Gastroenterology & Hepatology·Mana H VriesmanMarc A Benninga
Jun 20, 2020·The Journal of Pediatrics·Gabriela MorielDanica B Liberman

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