It is not what you do, it is the way that you do it: impact of a care pathway for appendicitis.

Abstract: Background/Purpose: Appendicitis is the most common surgical emergency in children. However, management varies widely. The aim of this study was to assess the impact of introducing a care pathway on the management of childhood appendicitis. Methods: Data were collected prospectively for 3 successive cohorts: Group A, before introduction of pathway; Group B, after introduction of pathway; Group C, after modification of pathway. All patients operated for suspected appendicitis were included. The pathway was modified after interim analysis of group B data. P < .05 was significant. Results: Six hundred patients were included. When compared with group A, group C patients were more likely to receive preoperative antibiotics (P < .0001), undergo formal pain assessment (P < .0001), and be operated before midnight (P = .025). There was a significant decrease in readmission rates from 10.0% to 4.2% (P = .023) despite an increase in cases of gangrenous and perforated appendicitis (P = .010). Conclusions: The introduction of a care pathway resulted in improved compliance with antibiotic regimens, more frequent pain assessment, and fewer post-midnight operations. Postappendicectomy readmission rates were reduced despite an increase in disease severity. This was achieved by critical reevaluation of outcomes and pathway redesign where appropriate. [Copyright &y& Elsevier]