Standardized pathway for feeding tube placement reduces unnecessary surgery and improves value of care

Children requiring gastrostomy tubes (GT) have high resource utilization. In addition, wide variation exists in the decision to perform concurrent fundoplication, which can increase the morbidity of enteral access surgery. We implemented a hospital-wide standardized pathway for GT placement. The sta...

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Bibliographic Details
Published in:Journal of pediatric surgery 2020-06, Vol.55 (6), p.1013-1022
Main Authors: Devin, Courtney L., Linden, Allison F., Sagalow, Emily, Reichard, Kirk W., Vinocur, Charles D., Miller, Jonathan M., Goldin, Adam B., Berman, Loren
Format: Article
Language:English
Subjects:
Checklists
Fundoplication
Gastrostomy
Pathways
Quality improvement
Resource utilization
Standardization
Value-based care
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Summary:Children requiring gastrostomy tubes (GT) have high resource utilization. In addition, wide variation exists in the decision to perform concurrent fundoplication, which can increase the morbidity of enteral access surgery. We implemented a hospital-wide standardized pathway for GT placement. The standardized pathway included mandatory preoperative nasogastric feeding tube (FT) trial, identification of FT medical home, and standardized postoperative order set, including feeding regimen and parent education. An algorithm to determine whether concurrent fundoplication was indicated was also created. We identified children referred for GT placement from 2015 to 2018 and compared concurrent fundoplication rates and outcomes pre- and postimplementation. We identified 332 patients who were referred for GT. Of these, 15 avoided placement. Concurrent fundoplication decreased postpathway (48% vs 22%, p 
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2020.02.033