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A simple care bundle to reduce unplanned admission rate for day case pediatric circumcision.
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- Additional Information
- Source:
Publisher: Arnette-Blackwell Country of Publication: France NLM ID: 9206575 Publication Model: Print Cited Medium: Internet ISSN: 1460-9592 (Electronic) Linking ISSN: 11555645 NLM ISO Abbreviation: Paediatr Anaesth Subsets: MEDLINE
- Publication Information:
Original Publication: Paris, France : Arnette-Blackwell, c1991-
- Subject Terms:
Circumcision, Male/
*statistics & numerical data ;
Day Care, Medical/
*statistics & numerical data ;
Patient Admission/
*statistics & numerical data ;
Patient Care Bundles/
*methods;
Anesthesia, Local/
methods ;
Anesthesia, Local/
statistics & numerical data ;
Anesthetics, Local/
administration & dosage ;
Child, Preschool ;
Circumcision, Male/
adverse effects ;
Circumcision, Male/
methods ;
Clinical Audit ;
Day Care, Medical/
organization & administration ;
Elective Surgical Procedures/
adverse effects ;
Elective Surgical Procedures/
methods ;
Elective Surgical Procedures/
statistics & numerical data ;
Hospitals, Pediatric/
statistics & numerical data ;
Humans ;
Infant ;
Infant, Newborn ;
Ireland/
epidemiology ;
Male ;
Pain, Postoperative/
drug therapy ;
Pain, Postoperative/
epidemiology ;
Patient Care Bundles/
statistics & numerical data ;
Quality Improvement/
statistics & numerical data ;
United Kingdom/
epidemiology - Abstract:
Background: An electronic review of unplanned day case admission rates in our hospital demonstrated an average annual rate for pediatric circumcision of 2%-3% in recent years with high levels of perioperative strong opiate use. This lay above target unplanned admission rates (<2%) set out by the Royal College of Anaesthetists for day case surgery. A targeted quality improvement initiative was undertaken to improve patient flow through the pediatric day case surgery unit for elective circumcision. Among the reasons for unplanned admission, factors modifiable by the anesthetist (pain, postoperative nausea and vomiting, somnolence) are significant contributors.
Methods: A prospective audit was undertaken over a 3-month period. Our practice was compared with evidence-based analgesic and antiemetic interventions in accordance the Association of Paediatric Anaesthetists of Great Britain and Ireland. Perioperative strong opiate administration rates occurred in 44% of cases. Four strategic interventions were selected based on quality of evidence, ease of implementation, and low cost: selection of higher concentration local anesthetic use for penile blocks, intravenous dexamethasone, and preoperative paracetamol combined with maximum dose nonsteroidal anti-inflammatory.
Results: The audit was duplicated a year later demonstrating a significant increase in application of these interventions with a parallel fall in strong opiate use from 44% to 9% and an unprecedented zero unplanned admission rate in our unit for 10 months in a row after implementation.
Conclusion: Regular scrutiny of patient electronic data helps identify high impact areas for audit and intervention. Unplanned admission in pediatric day case surgery is an area amenable to such targeted intervention.
(© 2018 John Wiley & Sons Ltd.)
- Contributed Indexing:
Keywords: NSAIDs; analgesia; anesthetics; circumcision; dexamethasone; dorsal penile nerve; local; male; paracetamol; quality improvement
- Accession Number:
0 (Anesthetics, Local)
- Publication Date:
Date Created: 20181011 Date Completed: 20190429 Latest Revision: 20190429
- Publication Date:
20231215
- Accession Number:
10.1111/pan.13474
- Accession Number:
30302885
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