It is not what you do, it is the way that you do it: impact of a care pathway for appendicitis

Background/Purpose: Appendicitis is the most common surgical emergency in children. However, management varies widely. The aim of this study was to assess the impact of introducing a care pathway on the management of childhood appendicitis. Methods: Data were collected prospectively for 3 successive cohorts: Group A, before introduction of pathway; Group B, after introduction of pathway; Group C, after modification of pathway. All patients operated for suspected appendicitis were included. The pathway was modified after interim analysis of group B data. P <.05 was significant. Results: Six hundred patients were included. When compared with group A, group C patients were more likely to receive preoperative antibiotics (P <.0001), undergo formal pain assessment (P :<.0001), and be operated before midnight (P =.025). There was. a significant decrease in readmission rates from 10.0% to 4.2% (P =.023) despite an increase in cases of gangrenous and perforated appendicitis (P =.010). Conclusions: The introduction of a care pathway resulted in improved compliance with antibiotic regimens, more frequent pain assessment, and fewer post-midnight operations. Postappendicectomy readmission rates were reduced despite an increase in disease severity. This was achieved by critical reevaluation of outcomes and pathway redesign where appropriate. (C) 2008 Elsevier Inc. All rights reserved.