Morgan K Richards1, Christopher I Li2, Jeffrey L Foti3, Michael G Leu4, Ghassan T Wahbeh5, Dennis Shaw6, Arlene K Libby7, Lilah Melzer8, Adam B Goldin9. 1. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States; Department of Surgery, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, Washington, 98195, United States. Electronic address: morgan.richards@gmail.com. 2. Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, Washington, 98109, United States. Electronic address: cili@fredhutch.org. 3. Division of General Pediatrics and Hospital Medicine, Department of Pediatrics, University of Washington, 1959 NE Pacific Street, Seattle, Washington, 98195, United States. Electronic address: jeffrey.foti@seattlechildrens.org. 4. Division of General Pediatrics and Hospital Medicine, Department of Pediatrics, University of Washington, 1959 NE Pacific Street, Seattle, Washington, 98195, United States; Department of Biomedical Informatics and Medical Education, University of Washington, 1959 NE Pacific Street, Seattle, Washington, 98195, United States. Electronic address: michael.leu@seattlechildrens.org. 5. Division of Gastroenterology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States. Electronic address: ghassan.wahbeh@seattlechildrens.org. 6. Division of Interventional Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States. Electronic address: dennis.shaw@seattlechildrens.org. 7. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States. Electronic address: arlene.libby@seattlechildrens.org. 8. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States. Electronic address: melzer.lilah@gmail.com. 9. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States. Electronic address: adam.goldin@seattlechildrens.org.
Abstract
BACKGROUND/ PURPOSE: Children requiring gastrostomy/gastrojejunostomy tubes (GT/GJ) are heterogeneous and medically complex patients with high resource utilization. We created and implemented a hospital-wide standardized pathway for feeding device placement. This study compares hospital resource utilization before and after pathway implementation. METHODS: We performed a retrospective cohort study comparing outcomes through one year of follow-up for consecutive groups of children undergoing GT/GJ placement prepathway (n=298, 1/1/2010-12/31/2011) and postpathway (n=140, 6/1/2013-7/31/2014) implementation. We determined the change in the rate of hospital resource utilization events and time to first event. RESULTS: Prior to implementation, 145 (48.7%) devices were placed surgically, 113 (37.9%) endoscopically and 40 (13.4%) using image guidance. After implementation, 102 (72.9%) were placed surgically, 23 (16.4%) endoscopically and 15 (10.7%) using image guidance. Prior to implementation, 174/298 (58.4%) patients required additional hospital resource utilization compared to 60/143 (42.0%) corresponding to a multivariate adjusted 38% reduced risk of a subsequent feeding tube related event. CONCLUSIONS: Care of tube-feeding dependent patients is spread among multiple specialists leading to variability in the preoperative workup, intraoperative technique and postoperative care. Our study shows an association between implementation of a standardized pathway and a decrease in hospital resource utilization.
BACKGROUND/ PURPOSE:Children requiring gastrostomy/gastrojejunostomy tubes (GT/GJ) are heterogeneous and medically complex patients with high resource utilization. We created and implemented a hospital-wide standardized pathway for feeding device placement. This study compares hospital resource utilization before and after pathway implementation. METHODS: We performed a retrospective cohort study comparing outcomes through one year of follow-up for consecutive groups of children undergoing GT/GJ placement prepathway (n=298, 1/1/2010-12/31/2011) and postpathway (n=140, 6/1/2013-7/31/2014) implementation. We determined the change in the rate of hospital resource utilization events and time to first event. RESULTS: Prior to implementation, 145 (48.7%) devices were placed surgically, 113 (37.9%) endoscopically and 40 (13.4%) using image guidance. After implementation, 102 (72.9%) were placed surgically, 23 (16.4%) endoscopically and 15 (10.7%) using image guidance. Prior to implementation, 174/298 (58.4%) patients required additional hospital resource utilization compared to 60/143 (42.0%) corresponding to a multivariate adjusted 38% reduced risk of a subsequent feeding tube related event. CONCLUSIONS: Care of tube-feeding dependent patients is spread among multiple specialists leading to variability in the preoperative workup, intraoperative technique and postoperative care. Our study shows an association between implementation of a standardized pathway and a decrease in hospital resource utilization.
Authors: Christina B Barreda; Mary L Ehlenbach; Allison Nackers; Michelle M Kelly; Kristin A Shadman; Daniel J Sklansky; M Bruce Edmonson; Qianqian Zhao; Gemma Warner; Ryan J Coller Journal: Pediatr Qual Saf Date: 2021-08-26
Authors: Benjamin A Goldstein; Marcelo Cerullo; Vijay Krishnamoorthy; Jeanna Blitz; Leila Mureebe; Wendy Webster; Felicia Dunston; Andrew Stirling; Jennifer Gagnon; Charles D Scales Journal: JAMA Netw Open Date: 2020-11-02