Implementation of a gastrostomy care bundle reduces dislodgements and length of stay
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Read the article on jpedsurg.org ↗Article · Oct 2020 · 1 min read
In brief
In brief
Interdisciplinary care bundle implementation reduced early gastrostomy tube dislodgements by 47% (from 43% to 19%) and cut median hospital length of stay in half (15.3 to 7.1 days). The quality improvement initiative achieved sustained compliance above 75% and demonstrated significant value improvement in pediatric G-tube care.
Written by the GCMD Library team from the article.
Abstract
Purpose
Pediatric gastrostomy tubes (G-tubes) are associated with considerable utilization of healthcare resources. G-tube dislodgement can result in tract disruption and abdominal sepsis. We aimed to reduce early G-tube dislodgement by 25%.
Methods
An interdisciplinary team convened to identify key drivers of G-tube dislodgement and implement initiatives to reduce this complication. A G-tube care bundle was implemented in 2018. Rates of early G-tube dislodgement (within 90 days of insertion) were tracked. 15 months of cases after bundle implementation were compared to 20 months of cases before implementation. Length of stay (LOS, balancing measure) and bundle compliance (process measure) were tracked.
Results
G-tube dislodgements decreased 47% after bundle implementation. Overall, dislodgements after G-tube insertion decreased from 43% to 19% dislodgements per tube inserted, p = 0.004. Reductions were observed for dislodgements occurring in both the inpatient (14% vs. 1.5%) and outpatient (29% vs. 18%) settings. Median LOS was reduced from 15.3 to 7.1 days following implementation, p = 0.004. Process measures demonstrated 75% or greater compliance one year after implementation.
Conclusion
An interdisciplinary team using quality improvement science methodology can significantly reduce G-tube dislodgement and improve value after pediatric gastrostomy tube insertion.
Type of study
Longitudinal cohort study.
Level of evidence
III.