Impact of a multidisciplinary care pathway on follow-up and emergency department utilisation in paediatric musculoskeletal infections.

UNLABELLED: To evaluate whether implementation of a multidisciplinary care pathway was associated with changes in unplanned emergency department (ED) visits in children with musculoskeletal infections, and to assess its impact on readmissions, reoperations, and key process measures. We conducted a single-centre quality-improvement study of children with septic arthritis (SA) or acute osteomyelitis (AO) treated at a tertiary paediatric hospital in Canada. A pathway introduced in September 2021 standardised C-reactive protein (CRP) monitoring, discharge documentation, and coordinated in-person and virtual follow-up. Consecutive post-pathway patients (September 2021-July 2022) were compared with a pre-pathway cohort (June 2018-August 2021). The primary outcome was unplanned ED visits within three months of discharge. Secondary outcomes included readmission, reoperation, and predefined process measures. Analyses used regression models and statistical process control (SPC) p-charts. A total of 122 children were included (77 pre-pathway, 45 post-pathway). Median age was similar between groups (4.0 vs 6.5 years, p = 0.25). Unplanned ED visits decreased from 28.6% to 17.8% (RR 0.62, 95% CI 0.30-1.28; p = 0.18). However, this difference was not statistically significant, and SPC analysis demonstrated common-cause variation. Pathway phase was not independently associated with ED visits after adjustment (OR 1.46, 95% CI 0.53-4.04; p = 0.47). Readmissions and reoperations were unchanged. Several process measures improved, including day-3 CRP measurement (61.0 vs 86.7%; p = 0.003), number of follow-up visits (median 3 vs 5; p < 0.001), and fewer missed appointments (median 1 vs 0; p < 0.001).

LEVEL OF EVIDENCE: Level III (Prospective comparative quality improvement study).

CONCLUSION

Implementation of a multidisciplinary care pathway was associated with improved process reliability and follow-up adherence. Although unplanned ED visits were lower in the post-pathway cohort, this difference did not reach statistical significance. These findings support coordinated, team-based approaches to optimise care processes for paediatric musculoskeletal infections.

WHAT IS KNOWN: • Children with septic arthritis and acute osteomyelitis frequently have unplanned emergency department visits after discharge, despite relatively low readmission and reoperation rates. • Care delivery often varies across the inpatient-outpatient continuum, with inconsistent inflammatory marker monitoring and limited multidisciplinary coordination.

WHAT IS NEW: • Implementation of a multidisciplinary care pathway was associated with improved CRP monitoring, follow-up adherence, and appointment reliability. • Although unplanned ED visits were numerically lower post-pathway, this difference did not reach statistical significance; however, process reliability and continuity of care improved without increases in readmissions or reoperations.