Surgical protocol nearly halves postoperative ED visits for pediatric urology patients

Editor's Note

A quality improvement protocol at the University of Colorado Anschutz Medical campus resulted in a 48.8% decrease in the number of pediatric urology patients returning to the emergency department (ED) unnecessarily within 30 days of surgery. According to a December 2 university report, the initiative has significantly reduced emotional and financial strain on families while helping to make better use of hospital resources.

In 2022, clinicians noted a rise in ED visits following procedures such as circumcision and hernia repair, the University reports. Many cases involved issues unrelated to surgery or minor concerns that could have been resolved through alternative methods, such as a phone call or brief clinic visit. Lengthy ED stays often ended with reassurance, incurring significant costs and unnecessary stress for families.

As detailed in the article, the team responded by revising discharge instructions to emphasize a 24/7 phone line staffed by nurses trained to triage concerns using a decision tree. This tool helped determine whether patients should visit the ED, attend a same- or next-day clinic appointment, or seek urgent care. Space was allocated in the clinic for rapid follow-up visits, streamlining access to care and avoiding ED overcrowding. The protocol also ensured ED staff were prepared for patients who were appropriately routed to the emergency department.

Six months after implementation, the inappropriate ED return rate dropped to 2.2%, down from pre-intervention levels, the University reports. The team plans to further refine the system by enhancing triage protocols and tracking clinic utilization.