R. N. Newton1, J. G. Daubendiek1, P. A. Holubeck1, B. L. Staple1, W. Terzian1 1University Of Nebraska College Of Medicine, College Of Medicine, Department Of Surgery, Omaha, NE, USA
Introduction:
The water-soluble contrast challenge (WSCC) has become the standard approach for differentiating operative from non-operative adhesive small bowel obstructions (ASBOs). An ingestible radiopaque contrast medium is followed by serial abdominal radiographs. Although well-described in theory, there are no resources available to guide administration of the WSCC, and management of ASBOs is usually dictated by individual surgeon practice. We hypothesized that a standardized approach to the WSCC would decrease hospital length of stay (LOS) and improve resource utilization.
Methods:
We developed an evidence-based pathway for managing ASBOs (Figure 1) on our emergency general surgery (EGS) service at UNMC. Inclusion criteria was patients over 18 years old admitted with a presumed ASBO based on CT scan. Exclusion criteria was built into the pathway and included patients presenting within six weeks of abdominal surgery and specific medical or surgical conditions. We retrospectively compared hospital LOS for patients admitted two years prior to implementation of our pathway (PRE) vs patients admitted for six months after implementation of the pathway (POST). Comparison of proportions was calculated using χ2 test.
Results:
A total of 165 patients were included (119 in the PRE group, 46 in the POST group). The mean LOS was 4.9 days in the PRE group vs 3.1 days in the POST group (p = 0.02), a reduction in LOS by 1.8 days, or 36%.
Conclusion:
Standardizing care on the EGD service significantly reduced hospital length of stay for patients with ASBOs. We are now piloting a revised pathway that can occur anytime on the floor to hopefully reduce LOS even further.
