Educational Module Improves Emergency Department Evaluation for Suspected Constipation

Objectives To determine abdominal radiograph use and frequency of digital rectal examinations in children presenting to the emergency department (ED) with abdominal pain and suspected constipation and to determine the impact of an educational module on their use. Study design Retrospective chart review of patients evaluated at a pediatric ED because of the complaint of abdominal pain who had the discharge diagnosis of constipation over two 2-month periods, one before and one after an educational module. Results Comparing pre- and posteducational module periods, there was a significant decrease in abdominal radiograph utilization (69.5% vs 26.4%, respectively, P  ≤ .001) and significant increase in performance of digital rectal examination (22.9% vs 47.3%, respectively, P  ≤ .001). We demonstrated a 33.6% reduction in abdominal radiograph in children who had a digital rectal examination as part of their examination. Overall, we demonstrated a 43.1% decrease in patients receiving an abdominal radiograph. When time and costs of an abdominal radiograph are considered, this results in significant cost savings. Conclusions An educational module reviewing the established criteria for the diagnosis of constipation and presented to ED providers results in increased use of digital rectal examination and decreased use of abdominal radiograph in patients evaluated for abdominal pain and ultimately diagnosed with constipation. The change also was associated with reduction in cost and time and radiation exposure in the ED for these patients.