Quality of care for acute abdominal pain in children

Yvonne Zurynski, Kate Churruca, Gaston Arnolda, Sarah Dalton, Hsuen P. Ting, Peter Damian Hibbert, Charlotte Molloy, Louise K. Wiles, Carl de Wet, Jeffrey Braithwaite

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective To assess quality of care for children presenting with acute abdominal pain using validated indicators. Design Audit of care quality for acute abdominal pain according to 21 care quality indicators developed and validated in four stages. Setting and participants Medical records of children aged 1–15 years receiving care in 2012–2013 were sampled from 57 general practitioners, 34 emergency departments (ED) and 28 hospitals across three Australian states; 6689 medical records were screened for visits for acute abdominal pain and audited by trained paediatric nurses. Outcome measures Adherence to 21 care quality indicators and three bundles of indicators: bundle A-History; bundle B-Examination; bundle C-Imaging. Results Five hundred and fourteen children had 696 visits for acute abdominal pain and adherence was assessed for 9785 individual indicators. The overall adherence was 69.9% (95% CI 64.8% to 74.6%). Adherence to individual indicators ranged from 21.6% for assessment of dehydration to 91.4% for appropriate ordering of imaging. Adherence was low for bundle A-History (29.4%) and bundle B-Examination (10.2%), and high for bundle C-Imaging (91.4%). Adherence to the 21 indicators overall was significantly lower in general practice (62.7%, 95% CI 57.0% to 68.1%) compared with ED (86.0%, 95% CI 83.4% to 88.4%; p<0.0001) and hospital inpatient settings (87.9%, 95% CI 83.1% to 91.8%; p<0.0001). Conclusions There was considerable variation in care quality for indicator bundles and care settings. Future work should explore how validated care quality indicator assessments can be embedded into clinical workflows to support continuous care quality improvement.
LanguageEnglish
Number of pages8
JournalBMJ Quality and Safety
DOIs
Publication statusE-pub ahead of print - 27 Nov 2019

Fingerprint

Quality of Health Care
Acute Pain
Abdominal Pain
Medical Records
Hospital Emergency Service
Patient Care Bundles
History
Workflow
Quality Improvement
Dehydration
General Practice
General Practitioners
Inpatients
Outcome Assessment (Health Care)

Keywords

  • clinical practice guidelines
  • general practice
  • paediatrics
  • quality improvement

Cite this

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title = "Quality of care for acute abdominal pain in children",
abstract = "Objective To assess quality of care for children presenting with acute abdominal pain using validated indicators. Design Audit of care quality for acute abdominal pain according to 21 care quality indicators developed and validated in four stages. Setting and participants Medical records of children aged 1–15 years receiving care in 2012–2013 were sampled from 57 general practitioners, 34 emergency departments (ED) and 28 hospitals across three Australian states; 6689 medical records were screened for visits for acute abdominal pain and audited by trained paediatric nurses. Outcome measures Adherence to 21 care quality indicators and three bundles of indicators: bundle A-History; bundle B-Examination; bundle C-Imaging. Results Five hundred and fourteen children had 696 visits for acute abdominal pain and adherence was assessed for 9785 individual indicators. The overall adherence was 69.9{\%} (95{\%} CI 64.8{\%} to 74.6{\%}). Adherence to individual indicators ranged from 21.6{\%} for assessment of dehydration to 91.4{\%} for appropriate ordering of imaging. Adherence was low for bundle A-History (29.4{\%}) and bundle B-Examination (10.2{\%}), and high for bundle C-Imaging (91.4{\%}). Adherence to the 21 indicators overall was significantly lower in general practice (62.7{\%}, 95{\%} CI 57.0{\%} to 68.1{\%}) compared with ED (86.0{\%}, 95{\%} CI 83.4{\%} to 88.4{\%}; p<0.0001) and hospital inpatient settings (87.9{\%}, 95{\%} CI 83.1{\%} to 91.8{\%}; p<0.0001). Conclusions There was considerable variation in care quality for indicator bundles and care settings. Future work should explore how validated care quality indicator assessments can be embedded into clinical workflows to support continuous care quality improvement.",
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author = "Yvonne Zurynski and Kate Churruca and Gaston Arnolda and Sarah Dalton and Ting, {Hsuen P.} and Hibbert, {Peter Damian} and Charlotte Molloy and Wiles, {Louise K.} and {de Wet}, Carl and Jeffrey Braithwaite",
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Quality of care for acute abdominal pain in children. / Zurynski, Yvonne; Churruca, Kate; Arnolda, Gaston; Dalton, Sarah; Ting, Hsuen P.; Hibbert, Peter Damian; Molloy, Charlotte; Wiles, Louise K.; de Wet, Carl; Braithwaite, Jeffrey.

In: BMJ Quality and Safety, 27.11.2019.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Quality of care for acute abdominal pain in children

AU - Zurynski, Yvonne

AU - Churruca, Kate

AU - Arnolda, Gaston

AU - Dalton, Sarah

AU - Ting, Hsuen P.

AU - Hibbert, Peter Damian

AU - Molloy, Charlotte

AU - Wiles, Louise K.

AU - de Wet, Carl

AU - Braithwaite, Jeffrey

PY - 2019/11/27

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N2 - Objective To assess quality of care for children presenting with acute abdominal pain using validated indicators. Design Audit of care quality for acute abdominal pain according to 21 care quality indicators developed and validated in four stages. Setting and participants Medical records of children aged 1–15 years receiving care in 2012–2013 were sampled from 57 general practitioners, 34 emergency departments (ED) and 28 hospitals across three Australian states; 6689 medical records were screened for visits for acute abdominal pain and audited by trained paediatric nurses. Outcome measures Adherence to 21 care quality indicators and three bundles of indicators: bundle A-History; bundle B-Examination; bundle C-Imaging. Results Five hundred and fourteen children had 696 visits for acute abdominal pain and adherence was assessed for 9785 individual indicators. The overall adherence was 69.9% (95% CI 64.8% to 74.6%). Adherence to individual indicators ranged from 21.6% for assessment of dehydration to 91.4% for appropriate ordering of imaging. Adherence was low for bundle A-History (29.4%) and bundle B-Examination (10.2%), and high for bundle C-Imaging (91.4%). Adherence to the 21 indicators overall was significantly lower in general practice (62.7%, 95% CI 57.0% to 68.1%) compared with ED (86.0%, 95% CI 83.4% to 88.4%; p<0.0001) and hospital inpatient settings (87.9%, 95% CI 83.1% to 91.8%; p<0.0001). Conclusions There was considerable variation in care quality for indicator bundles and care settings. Future work should explore how validated care quality indicator assessments can be embedded into clinical workflows to support continuous care quality improvement.

AB - Objective To assess quality of care for children presenting with acute abdominal pain using validated indicators. Design Audit of care quality for acute abdominal pain according to 21 care quality indicators developed and validated in four stages. Setting and participants Medical records of children aged 1–15 years receiving care in 2012–2013 were sampled from 57 general practitioners, 34 emergency departments (ED) and 28 hospitals across three Australian states; 6689 medical records were screened for visits for acute abdominal pain and audited by trained paediatric nurses. Outcome measures Adherence to 21 care quality indicators and three bundles of indicators: bundle A-History; bundle B-Examination; bundle C-Imaging. Results Five hundred and fourteen children had 696 visits for acute abdominal pain and adherence was assessed for 9785 individual indicators. The overall adherence was 69.9% (95% CI 64.8% to 74.6%). Adherence to individual indicators ranged from 21.6% for assessment of dehydration to 91.4% for appropriate ordering of imaging. Adherence was low for bundle A-History (29.4%) and bundle B-Examination (10.2%), and high for bundle C-Imaging (91.4%). Adherence to the 21 indicators overall was significantly lower in general practice (62.7%, 95% CI 57.0% to 68.1%) compared with ED (86.0%, 95% CI 83.4% to 88.4%; p<0.0001) and hospital inpatient settings (87.9%, 95% CI 83.1% to 91.8%; p<0.0001). Conclusions There was considerable variation in care quality for indicator bundles and care settings. Future work should explore how validated care quality indicator assessments can be embedded into clinical workflows to support continuous care quality improvement.

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