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Advanced Practice Nurse Phone Follow-Up Initiative to Reduce Unplanned Returns for Perforated Appendicitis Patients

Micalizzi, Rosella A., MSN, RN, CPNP-PC; Phinney, Caitlin, MSN, RN, FNP-BC; Lemire, Lindsay, MSN, RN, FNP-BC, FNP-C; O’Donnell, Ellen A., MSN, RN, CPNP-PC

Journal of Pediatric Surgical Nursing: July/September 2018 - Volume 7 - Issue 3 - p 93–99
doi: 10.1097/JPS.0000000000000183
Feature Article

Introduction: Perforated appendicitis is a high-volume diagnosis managed by advanced practice nurses (APNs) in the general pediatric surgery department at an urban hospital in the northeast. This APN-led quality improvement project aimed to determine the impact of APN phone follow-up to prevent unplanned return visits and readmission.

Methods: Before June 2015, all patients with perforated appendicitis discharged home on antibiotic therapy were provided with APN phone follow-up. The patients were followed for 30-day outcomes regarding unplanned returns to care. The goal was to attempt to identify patients at a higher risk for returns based on symptom analysis so that preventative measures may be instituted. The process of phone follow-up for patients with perforated appendicitis changed in June 2015 because of the decreased number of patients discharged home on intravenous antibiotic therapy, and therefore the phone follow-up was discontinued. This allowed the data from the first cohort (December 2014 to May 2015) to be reviewed by a retrospective chart review and analyzed.

Outcomes: The preliminary data between the two cohorts, which have comparable patient volumes and return rates, have revealed that the APN phone follow-up did not necessarily change the rate of unplanned return-to-care visits after patient discharge, perhaps because of the call being conducted too soon after discharge. Our findings suggested that the APN phone follow-up call may have been more impactful in reducing unplanned return-to-care visits if completed after the 48-hour time frame.

Rosella A. Micalizzi, MSN, RN, CPNP-PC Advanced Practice Nurse, Department of Surgery, Boston Children’s Hospital, Boston, MA.

Caitlin Phinney, MSN, RN, FNP-BC Advanced Practice Nurse, Department of Surgery, Boston Children’s Hospital, Boston, MA.

Lindsay Lemire, MSN, RN, FNP-BC, FNP-C Advanced Practice Nurse, Department of Surgery, Boston Children’s Hospital, Boston, MA.

Ellen A. O’Donnell, MSN, RN, CPNP-PC Advanced Practice Nurse, Department of Surgery, Boston Children’s Hospital, Boston, MA.

The authors have declared no conflict of interest.

Correspondence: Ellen A. O’Donnell, MSN, RN, CPNP-PC Department of General Surgery, Boston Children’s Hospital, Fegan 3, 300 Longwood Ave., Boston, MA 02115. E-mail: ellen.odonnell@childrens.harvard.edu

Copyright © 2018 American Pediatric Surgical Nursing Association
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