Implementing Evidence-Based Practices to Improve Outcomes for Small Bowel Obstruction

From the 2019 HVPAA National Conference

Dr. Joshua Tseng (Cedars-Sinai Medical Center), Dr. Harry Sax (Cedars-Sinai Medical Center), Dr. Rodrigo Alban (Cedars-Sinai Medical Center)


Small bowel obstruction (SBO) is a common general surgical condition in the United States. The optimal strategy for diagnosis and management of SBO continues to evolve with advances in imaging and medical management, including the use of oral contrast as a diagnostic and therapeutic modality for SBO.


A multidisciplinary team evaluated the hospital course for patients admitted to a single-center academic institution with the MS-DRG for G. I. Obstruction (389, 390). In the intervention, a set of recommendations based on evidence-based practices was developed for the general medical staff. In addition, an alert in the electronic medical record system was implemented to recommend the use of oral contrast for patients admitted with small bowel obstruction. Pre-intervention (July 2017 to September 2018) and post-intervention (October 2018 to March 2019) hospital length of stays were compared.


A total of 237 patients who were admitted with the MS-DRG for G. I. Obstruction were identified. Pre-intervention, the mean hospital length of stay for this cohort was 4.03 days. Post-intervention, the mean hospital length of stay decreased to 3.70 days.


By developing a set of evidence-based recommendations for the management of SBO and utilizing electronic medical record alerts to encourage best practices, our institution significantly decreased the average length of stay for patients admitted with small bowel obstruction.

Clinical Implications

The electronic medical record system can be used to encourage the use of evidence-based practices.


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