A New Model of Care at Dell Children’s Hospital

Problem:

Functional abdominal pain is a common, multifactorial, chronic and often debilitating condition that affects up to 20 percent of children worldwide. The diagnosis is often associated with longer hospital stays and is challenging from a pain management perspective. Multiple studies demonstrate decreased quality of life, increased school absences, and poor school performance among children with functional abdominal pain compared to their peers.

Intervention:

In September 2016, Dell Children’s established a large multi-disciplinary work group to collaborate and develop a comprehensive, integrated approach to the treatment of functional abdominal pain. Experts believe that functional abdominal pain is best approached with the biopsychosocial model which is based on an interplay of genetic, physiologic and psychological factors.

The team began by reviewing case studies of pediatric patients discharged with a diagnosis of chronic abdominal pain and then reviewed an extensive list of evidence-based reference material.  The team learned that current conventional treatments were often ineffective and that chronic abdominal pain patients had high readmission rates and low levels of satisfaction with their care.

During 2017, the work group utilized an integrated approach to the inpatient treatment of these children and helped improve and standardize care for patients with chronic abdominal pain in the following ways:

  1. A decision to admit patients presenting with abdominal pain to 4 North whenever possible.
  2. Extensive training, including:
    1. Workshops and teaching sessions for faculty, residents, interns
    2. Development of an online module for nursing and other staff including diagnostic criteria and plans of care
    3. FODMAP diets and menu options for the patient
  3. A team approach to care using a patient-centered hospital plan, with optimized communication skills and appropriate consultation from interdisciplinary clinicians.
  4. Development of family education documents, including explanations of pathophysiology, treatment goals, and specific, individualized recommendations, instructions for home and when to call the physician.

Looking ahead, the work group is working on implementing alternative therapies such hypnosis, acupuncture, mindfulness, meditation, guided imagery and abdominal yoga as that are growing in favor with increasing evidence in clinical studies.

Evidence-Based Practice

In past decades, functional abdominal pain was almost solely encountered in the ambulatory setting. Now patients are increasingly admitted to the hospital for either diagnostic evaluation or symptom management in light of ineffective traditional pharmacologic interventions. Research demonstrates that children with chronic pain complaints represent a growing number of general pediatric inpatient admissions. From 2004 to 2010, the number of pediatric chronic pain diagnoses increased by 831%, of which chronic abdominal pain was the most common admission diagnosis. The substantial and progressively escalating economic burden extends from increased hospitalization to more extensive diagnostic tests to “rule-out” an underlying organic etiology and often futile escalations of pharmacologic management.