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STANDARDIZED PROCESS TO IMPROVE PATIENT FLOW FROM THE EMERGENCY
ROOM (ER) TO THE OPERATING ROOM (OR) FOR PEDIATRIC PATIENTS WITH
TESTICULAR TORSION
Cagatay E. AFSARLAR
1
, Edward DONEL
2
, Beth JONES
3
, Barkha CHANDWANI
1
, Jason AU
1
, Irina STANASEL
1
, Edmond T.
GONZALES
1
, Nicolette JANZEN
1
, Patricio GARGOLLO
1
, Abhishek SETH
1
, David R. ROTH
1
and Chester J. KOH
1
1) Texas Children's Hospital / Baylor College of Medicine, Division of Pediatric Urology / Department of Urology,
Houston, USA - 2) Texas Children's Hospital / Baylor College of Medicine, Outcomes & Impact Service, Houston, USA -
3) Texas Children's Hospital / Baylor College of Medicine, PACU/SDS, Houston, USA
PURPOSE
While delay in seeking medical attention is a common cause of testicular loss in pediatric patients with testicular torsion,
delays in diagnosis and treatment can be preventable causes of testicular loss. Our aim was to develop a standardized
process to improve the patient flow from the ER to the OR for these patients.
PATIENTS AND METHODS
30 consecutive pediatric patients with acute torsion between November 2013 and July 2014 served as the control
group. A scrotal pain checklist was implemented in July 2014, and 30 consecutive patients from July 2014 until April
2015 served as the study group. Perioperative parameters including times, ultrasound (US) findings, and surgical results
were reviewed.
RESULTS
The mean ages of the control group and the study group were similar (12±4.9 and 11.7±5,
respectively) (p=0.799). ER arrival to OR time, triage completion to OR time, and scrotal US to OR time were
significantly decreased in the study group (p<0.001). Although triage time and ER arrival to scrotal US times were
decreased in the study group, the differences were not significant (p=0.058, p=0.243, respectively).
CONCLUSIONS
A standardized process with use of a scrotal pain checklist and prompt communication between ER, urology and
radiology teams led to significantly reduced times from ER to the OR. Although increased awareness of the time
sensitivity (Hawthorne effect) may be contributory, standardized processes for pediatric patients with testicular torsion
should help to improve testicular survival rates.