The following is a summary of “A Quality Improvement Initiative to Reduce Abdominal X-ray use in Pediatric Patients Presenting with Constipation,” published in the December 2022 issue of Pediatrics by McSweeney, et al.

For a study, researchers sought to reduce the proportion of patients who, within 24 hours of their initial GI appointment, got an abdominal radiograph for the assessment of constipation.

A quality improvement, evidence-based guideline (EBG) was put into place in January 2015 to standardize the first evaluation of patients who were coming in for their first outpatient gastroenterology appointment with constipation as their main complaint. They monitored the clinical effects of this guideline’s implementation for the next five years to reduce the usage of unneeded abdominal radiographs by 10% within a year of the EBG debut. Patients with a minimum age of 6 months and a maximum age of 19 years were included.

Between 2013 and 2019, 6,723 individuals underwent new patient gastroenterology consultations with constipation as their major diagnosis. Within 24 hours after their initial visit, abdominal radiographs were performed for 993 (14.8%) of these individuals. The average number of abdominal radiographs ordered dropped from 24% to less than 11% during the course of the project’s seven years. In addition, it was discovered that less radiograph usage for constipation was associated with a 57% drop in hospital expenses. Within 30 days of the patients’ first visits, there were no increases in future trips to the ER or hospitalizations for constipation.

The usual usage of abdominal radiographs collected at a patient’s initial outpatient gastroenterology appointment for constipation fell by more than 50% as a result of the local adoption of an EBG. Without experiencing any negative side effects, the decrease was kept up over the next five years.