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Pediatric Urology Perioperative Improvement (PUPPI) Project

Friday, October 19, 2012: 10:50 AM
Room 208-209 (Morial Convention Center)
Sue M. Hadden, BSN, RN1, Kate H. Kraft, MD2, David A. Bloom, MD2, Carla K. Garwood, RN1, Vesna Ivancic2, Sandy Ratliff-Ahmed, RN, BSN1, Julian Wan, MD2 and John M. Park, MD2, (1)Pediatric Urology, University of Michigan Health System, CS Mott Children's Hospital, Ann Arbor, MI, (2)Urology, University of Michigan, Ann Arbor, MI

Purpose: Caregivers whose children undergo hypospadias repair are required to learn postoperative care in a short period of time, usually with no previous medical knowledge.  Often, discharge instructions are reviewed with families at the time of discharge or when their child is recovering from anesthesia in the post anesthesia care unit (PACU). This is often a stressful time and a time when it is difficult for families to remember postoperative care information.  

Deficits in postoperative care knowledge have been shown to increase family anxiety, decrease satisfaction and negatively affect postoperative outcomes.  To improve education for families, we started the Pediatric Urology Perioperative Process Improvement Project.  Care instructions are provided in a simulation lab environment while the child is in surgery.  A variety of learning tools are used including written material and a hands-on practicum.

Methods: Data including patient demographics, recovery times, and number/type of postoperative clinic calls, Emergency Department visits, and unscheduled postoperative clinic visits was prospectively collected of patients whose families received PUPPI teaching.  The same data of patients undergoing hypospadias repair one year prior to initiating the PUPPI Project was compared.  A satisfaction questionnaire was completed by families who received PUPPI teaching.  Statistical analysis was conducted with the Wilcoxon rank sum test and chi-square or Fisher exact test as indicated.

Results: 67 pre-PUPPI patients were compared to 56 post-PUPPI patients.  Mean age in the pre group is 1.34 years (SD 0.69, range 0.50-3.57) and in the post group is 1.55 years (SD 2.51 years, range 0.47-15.82, p=0.038).  Mean PACU time for the post group (102.76 min, SD 42.87, range 21-290) is decreased compared to the pre group (109.11 min, SD 38.21, range 43-201), although this is not statistically significant (p=0.338).  The number of clinic calls between the pre and post groups did not change significantly (52 vs. 53, p=0.145) the first week following surgery. There was a decrease in calls from 14 to 3 (p=0.032) in the second week following surgery. Number of calls about the catheter, dressing, or wound appearance was unchanged (40 vs. 47, p=0.076).  5 pre patients and 7 post patients returned to the ED for surgery-related concerns (p=0.372).   2 pre patients and 1 post patient returned to clinic before their scheduled postoperative visit (p=0.555).  89.5% (n=17) of 19 families who completed a questionnaire gave a 4 or 5 (agree, strongly agree) on a 5-point Likert scale assessing satisfaction with specific aspects of PUPPI teaching.

Conclusion: Multi-modal educational techniques for postoperative education resulted in high satisfaction ratings. PUPPI teaching may reduce PACU times, although this is not statistically significant.  Additionally, in the second postoperative week, there is a reduction in the number of clinic calls.