P2.292: Urgent Care Quality Improvement: Moving Abdominal X-rays out of the Diagnosis of Constipation

Purpose/Objectives: Abdominal x-rays (AXR) expose children to unnecessary radiation and are not indicated in the diagnostic evaluation of pediatric constipation. Reducing AXR is one of five priorities for the Choosing Wisely in Pediatric Emergency Medicine initiative. Our Aim was to decrease the utilization of AXR in patients with constipation seen in our Urgent Care (UC) from a baseline of 25% to less than 18%. Our secondary aim was to evaluate for differences in utilization of AXR by language.

Design/Methods: Interventions included provider education on Choosing Wisely guidelines, as well as audit, feedback and frequent data sharing among clinicians in UC. Statistical process control (SPC) charts were created to monitor utilization of AXRs in the diagnosis of constipation. Data were stratified by language. Balancing measures included UC visit length of stay (LOS) and emergency room visit or hospitalization within 72 hours in patients who did not receive an AXR.

Results: Baseline data from October 2020 through May 2022 included 1616 patients with constipation and showed utilization of AXR of 25.7%. Interventions began in July 2022. AXR use decreased to16%, with a downward shift in the centerline, starting in June 2023 (Figure 1a). These changes met criteria for special cause variation. The baseline utlization of AXR was similar for English and language other than English (LOE) patients and decreased over time for both groups (Figure 1b). Balancing measures demonstrated decreased LOS for all patients with constipation over the study period; patients who received AXR had longer LOS compared with those who did not (Figure 2a). There was no increase in unplanned 72-hour ED returns or hospitalizations (Figure 2b).

Conclusion/Discussion: Provider education, audit and feedback, and regular data sharing decreased utilization of AXR in children presenting to UC with constipation, including for patients receiving care in a language other than English. Quality improvement strategies can enable providers to adhere to evidence-based recommendations to safely do less.