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Abstract

Credits:

Study data were collected and managed using REDCap electronic data capture tools hosted at the Children’s Foundation Research Institute - Biomedical Informatics Core and the University of Tennessee Health Science Center (Harris et al., 2009). Research Electronic Data Capture is a secure, Web-based application designed to support data capture for research studies, providing (a) an intuitive interface for validated data entry, (b) audit trails for tracking data manipulation and export procedures, (c) automated export procedures for seamless data downloads to common statistical packages, and (d) procedures for importing data from external sources.

Introduction

Various feeding regimens are used for infants after pyloromyotomy for hypertrophic pyloric stenosis (HPS). A few studies have shown that standardized feeding regimens (SFRs) can decrease length of hospital stay. In January 2010, a freestanding academic children’s hospital converted to Computerized Provider Order Entry (CPOE), and standard order sets were implemented. A postoperative order set was devised for patients with HPS, and an SFR was specified.

Purpose

The aim of this study was to measure impact of a CPOE-driven SFR on postoperative length of stay (LOS) after laparoscopic pyloromyotomy.

Methods

A retrospective review of patients admitted with HPS who underwent laparoscopic pyloromyotomy from July 2007 to October 2009 (pre-CPOE) and from April 2010 to July 2012 (post-CPOE) at a free-standing academic children’s hospital was conducted. LOS was defined as the time from surgery to time discharge orders were written.

Results

There was no difference in the LOS between the pre- and post-CPOE groups. There was also no difference in the time from surgery to time discharge criteria were met between the two groups. No differences in frequency of emesis, 30-day readmit, or complication rates were seen. Physician compliance to use of CPOE SFR was 99.3%.

Conclusions

Design and implementation of a CPOE order set for the postoperative care of patients after pyloromyotomies utilizing an SFR did not impact the postoperative LOS. However, it can be used to produce consistent care without significantly increasing complication rates or 30-day readmits.

Keywords

CPOE feeding regimen hypertrophic pyloric stenosis laparoscopic pyloromyotomy Medical Order Entry Systems

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References

Abide O. O., Iqbal C. W., Sharp S. W., Juang D., Snyder C. L., Holcomb G. W., … St. Peter S. D. (2014). Protocol versus ad libitum feeds after laparoscopic pyloromyotomy: A prospective randomized trial. Journal of Pediatric Surgery, 49, 129–132. doi:10.1016/j.pedsurg.2013.09.044

Abide O. O., Nichol P. F., Lim F. Y., Mattei P. (2007). Ad libitum feeds after laparoscopic pyloromyotomy: A retrospective comparison with a standardized feeding regimen in 227 infants. Journal of Laparoendoscopic and Advanced Surgical Techniques, 17 (2), 235–237. doi:10.1089/lap.2006.0143

Ashcraft K. (2010). Lesions of the stomach. In Ashcraft’s pediatric surgery (5th ed.). Philadelphia, PA: Saunders/Elsevier.

Carpenter R. O., Schaffer R. L., Maeso C. E., Sasan F., Nuchtern J. G., Jaksic T., Brandt M. L. (1999). Postoperative ad lib feeding for hypertrophic pyloric stenosis. Journal of Pediatric Surgery, 34 (6), 959–961.

Computerized Provider Order Entry. (2014). Retrieved from http://www.healthit.ahrq.gov/key-topics/computerized-provider-order-entry

Devine E. B., Hansen R. N., Wilson-Norton J. L., Lawless N. M., Fisk A. W., Blough D. K., … Sullivan S. D. (2010). The impact of computerized provider order entry on medication errors in a multispecialty group practice. Journal of American Medical Informatics Association, 17, 78–84. doi:10.1197.jamia.m3285

Garza J. J., Morash D., Dzakovic A., Mondschein J. K., Jaksic T. (2002). Ad libitum feeding decreases hospital stay for neonates after pyloromyotomy. Journal of Pediatric Surgery, 37 (3), 493–495.

Harris P. A., Taylor R., Thielke R., Payne J., Gonzalez N., Conde J. E. (2009) Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42 (2): 377–81.

Keene A., Ashton L., Shure D., Napoleone D., Katyal C., Bellin E. (2007). Mortality before and after initiation of a computerized physician order entry system in a critically ill pediatric population. Pediatric Critical Care Medicine, 8 (3), 268–271. doi:10.1097.01.pcc.0000260781.78277.d9

10.

Leinwand M. J., Shaul D. B., Anderson K. D. (2000). A standardized feeding regimen for hypertrophic pyloric stenosis decreases length of hospitalization and hospital costs. Journal of Pediatric Surgery, 35 (7), 1063–1065. doi:10.1053/js.2000.7772

11.

Michalsky M. P., Pratt D., Caniano D. A., Teich S. (2002). Streamlining the care of patients with hypertrophic pyloric stenosis: Application of a clinical pathway. Journal of Pediatric Surgery, 37 (7), 1072–1075. doi:10.1053/jpsu.2002.33847

12.

Morash D. (2002). An interdisciplinary project that changed practice in feeding methods after pyloromyotomy. Pediatric Nursing, 28 (2), 113–137.

13.

Puapong D., Kahng D., Ko A., Applebaum H. (2002). Ad libitum feeding: Safely improving the cost- effectiveness of pyloromyotomy. Journal of Pediatric Surgery, 37 (12), 1667–1668. doi:10.1053/jpsu.2002.36687

14.

Spalding S. C., Mayer P. H., Ginde A. A., Lowenstein S. R., Yaron M. (2011). Impact of computerized physician order entry on ED patient length of stay. American Journal of Emergency Medicine, 29, 207–211. doi:10.1016/j.ajem.2009.10.007

15.

Stone W. M., Smith B. E., Shaft J. D., Nelson R. D., Money S. R. (2009). Impact of a computerized physician order entry system. Journal of the American College of Surgeons, 208 (5), 960–967. doi:10.1016/j.jamcollsurg.2009.01.042

Impact of Standardized Postoperative Feeding Regimen After Laparoscopic Pyloromyotomy Utilizing a Computerized Provider Order Entry Order Set