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Rate of X-Ray Can Be Reduced for Constipation in Pediatric ER

Rational subgrouping, stratification on statistical process control charts can cut abdominal radiographs

a child boy during an exam in a hospital

WEDNESDAY, June 14, 2017 (HealthDay News) -- The rate of abdominal radiograph (AXR) use can be reduced in the pediatric emergency department setting with use of rational subgrouping and stratification on statistical process control (SPC) charts, according to a study published online June 14 in Pediatrics.

Catherine Craun Ferguson, M.D., from the Medical College of Wisconsin in Milwaukee, and colleagues conducted an interventional improvement project at a large urban pediatric emergency department. They examined the proportion of low-acuity patients aged 6 months to 18 years ultimately diagnosed with constipation who underwent an AXR during their emergency department visit, with the aim being to decrease the percentage from 60 to 20 percent over 12 months.

The researchers performed process analysis using a cause-and-effect diagram. Over nine months, four plan-do-study-act cycles were completed. Holding Grand Rounds on constipation, sharing best practices, metrics reporting, and academic detailing were included as interventions. To target the interventions to different emergency department provider groups, rational subgrouping and stratification on SPC charts were used. There was a significant and sustained decrease over 12 months, from a mean rate of 62 percent to a mean rate of 24 percent in utilization of AXRs in the emergency department.

"The use of rational subgrouping and stratification on SPC charts to study different emergency department provider groups resulted in a substantial and sustained reduction in the rate of AXRs for constipation," the authors write.

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