A Gastroschisis bundle: effects of a quality improvement protocol on morbidity and mortality
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Read the article on jpedsurg.org ↗Article · Jul 2018 · 1 min read
In brief
In brief
Quality improvement protocol for out-born gastroschisis patients in an underdeveloped country reduced mortality from 22% to 2%. The bundle included facilitated transport, bedside reduction without anesthesia, sutureless closure, PICC lines, and early feeding, significantly decreasing mechanical ventilation use and sepsis rates.
Written by the GCMD Library team from the article.
Objective
Gastroschisis incidence is rising. Survival in developed countries is over 95%. However, in underdeveloped countries, mortality is higher than 15% often due to sepsis. The aim of this study was to evaluate the effect on morbidity and mortality of a Quality Improvement Protocol for out-born gastroschisis patients.
Methods
The protocol consisted in facilitating transport, primary or staged reduction at the bedside and sutureless closure, without anesthesia, PICC lines and early feeding. Data was prospectively collected for the Protocol Group (PG) treated between June 2014 through March 2016 and compared to the last consecutive patients Historical Group (HG). Primary outcome was mortality. Secondary outcomes: need for and duration of mechanical ventilation (MV), time to first feed (TFF) after closure, parenteral nutrition (TPN), length of stay (LOS) and sepsis. Data were analyzed using χ2 and Mann–Whitney U tests.
Results
92 patients were included (46 HG and 46 PG). Demographic data were homogeneous. Mortality decreased from 22% to 2% (p = 0.007). Mechanical ventilation use decreased from 100% to 57% (p =