The Snappy Appy Diagnosis: In Emergency Department Patients, Does Scanning without Oral Contarst Provide an Accurate and More Timely Diagnosis than Scanning with Oral Contrast?

2.50
Hdl Handle:
http://hdl.handle.net/10755/306622
Category:
Abstract
Type:
Poster
Title:
The Snappy Appy Diagnosis: In Emergency Department Patients, Does Scanning without Oral Contarst Provide an Accurate and More Timely Diagnosis than Scanning with Oral Contrast?
Author(s):
Watkins, Erica
Lead Author STTI Affiliation:
Non-member
Author Details:
Erica Watkins, BSN, RN, CEN, erica.watkins@hcahealthcare.com
Abstract:

Evidence-based Practice Abstract

Purpose: Administration of oral contrast in diagnosing appendicitis contributes to delayed diagnosis, increased patient risk, discomfort related to drinking contrast while experiencing nausea and pain, and increased time in the Emergency Department. This issue concerns ED nursing practice because a quicker diagnosis means less risk for the patient associated with possible rupture, allergy to contrast, naso-gastric tube placement due to vomiting of contrast, and additional doses of narcotics and anti-emetics administered. Also, patient satisfaction is now related to hospital compensation. Shorter ED stays can increase satisfaction scores. .

Design: Evidence Based practice project focused on reducing length of stay in the Emergency Department. Data obtained through retrospective chart review. .

Setting: 25 bed Urban Emergency Department averaging 50,000 visits per year..

Participants/Subjects: All patients diagnosed with appendicitis during May, June, and July of 2009, and the same months of 2012. Patients diagnosed with appendicitis by CT scan prior to arrival were excluded..

Methods: The literature was presented to the Emergency Department Medical Director and the Head of Radiology with a proposal to begin scanning patients with a high suspicion of appendicitis without oral contrast. A new “Appy Protocol” with IV only contrast was created and communicated to staff. Appendicitis admissions were reviewed weekly to ensure that the protocol was followed. Any outliers were followed up. In order to determine pre-protocol context and baseline, all appendicitis diagnosis for May, June, and July 2009 were reviewed for arrival to diagnosis time, use of anti-emetics, and contrast use. This constructed baseline data from before physicians began ordering appendicitis scans without oral contrast. (Some physicians had begun ordering CT without contrast though this was not the current protocol). Appendicitis diagnosis for May and June 2012 were reviewed for the same data. July will be reviewed when the month is complete..

Results/Outcomes: The baseline data revealed that in 2009, the average arrival to diagnosis time for appendicitis was 300 minutes, which was 45 minutes longer than for all admissions averaged. After implementing the Appy Protocol, the percentage of scans completed without oral contrast increased from 34% in 2009 to 62% in 2012 with a rescan rate of only 0.04%. Average arrival to diagnosis for all patients diagnosed with appendicitis decreased from 300 minutes in 2009 to 201 minutes in 2012. It is expected that this trend will continue in July. It should be noted that part of this overall decrease in arrival to diagnosis is due to a staging protocol implemented in the Emergency Department that focuses on nurse driven protocols and immediate bedding. However, with the increased number of scans done without oral contrast, the new protocol does contribute to increased throughput..

Implications: An appendicitis protocol that includes scanning with IV only contrast decreases the time from admission to diagnosis, therefore increasing ED throughput while maintaining an accurate diagnosis with less risk to the patient..

Keywords:
Scanning and Oral Contrast
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Leadership Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Ft. Lauderdale, Florida, USA
Description:
2013 ENA Leadership Conference Theme: Shape the Future. Held at the Greater Fort Lauderdale Broward County Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleThe Snappy Appy Diagnosis: In Emergency Department Patients, Does Scanning without Oral Contarst Provide an Accurate and More Timely Diagnosis than Scanning with Oral Contrast?en_GB
dc.contributor.authorWatkins, Ericaen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsErica Watkins, BSN, RN, CEN, erica.watkins@hcahealthcare.comen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306622-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: Administration of oral contrast in diagnosing appendicitis contributes to delayed diagnosis, increased patient risk, discomfort related to drinking contrast while experiencing nausea and pain, and increased time in the Emergency Department. This issue concerns ED nursing practice because a quicker diagnosis means less risk for the patient associated with possible rupture, allergy to contrast, naso-gastric tube placement due to vomiting of contrast, and additional doses of narcotics and anti-emetics administered. Also, patient satisfaction is now related to hospital compensation. Shorter ED stays can increase satisfaction scores. .</p><p>Design: Evidence Based practice project focused on reducing length of stay in the Emergency Department. Data obtained through retrospective chart review. .</p><p>Setting: 25 bed Urban Emergency Department averaging 50,000 visits per year..</p><p>Participants/Subjects: All patients diagnosed with appendicitis during May, June, and July of 2009, and the same months of 2012. Patients diagnosed with appendicitis by CT scan prior to arrival were excluded..</p><p>Methods: The literature was presented to the Emergency Department Medical Director and the Head of Radiology with a proposal to begin scanning patients with a high suspicion of appendicitis without oral contrast. A new “Appy Protocol” with IV only contrast was created and communicated to staff. Appendicitis admissions were reviewed weekly to ensure that the protocol was followed. Any outliers were followed up. In order to determine pre-protocol context and baseline, all appendicitis diagnosis for May, June, and July 2009 were reviewed for arrival to diagnosis time, use of anti-emetics, and contrast use. This constructed baseline data from before physicians began ordering appendicitis scans without oral contrast. (Some physicians had begun ordering CT without contrast though this was not the current protocol). Appendicitis diagnosis for May and June 2012 were reviewed for the same data. July will be reviewed when the month is complete..</p><p>Results/Outcomes: The baseline data revealed that in 2009, the average arrival to diagnosis time for appendicitis was 300 minutes, which was 45 minutes longer than for all admissions averaged. After implementing the Appy Protocol, the percentage of scans completed without oral contrast increased from 34% in 2009 to 62% in 2012 with a rescan rate of only 0.04%. Average arrival to diagnosis for all patients diagnosed with appendicitis decreased from 300 minutes in 2009 to 201 minutes in 2012. It is expected that this trend will continue in July. It should be noted that part of this overall decrease in arrival to diagnosis is due to a staging protocol implemented in the Emergency Department that focuses on nurse driven protocols and immediate bedding. However, with the increased number of scans done without oral contrast, the new protocol does contribute to increased throughput..</p><p>Implications: An appendicitis protocol that includes scanning with IV only contrast decreases the time from admission to diagnosis, therefore increasing ED throughput while maintaining an accurate diagnosis with less risk to the patient..</p>en_GB
dc.subjectScanning and Oral Contrasten_GB
dc.date.available2013-12-09T17:00:52Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:52Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Leadership Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationFt. Lauderdale, Florida, USAen_GB
dc.description2013 ENA Leadership Conference Theme: Shape the Future. Held at the Greater Fort Lauderdale Broward County Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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