Standardized pathway for feeding tube placement reduces unnecessary surgery and improves value of care
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Read the article on jpedsurg.org ↗Article · Mar 2020 · 1 min read
In brief
In brief
Hospital-wide standardized pathway for gastrostomy tube placement reduced concurrent fundoplication rates from 48% to 22% through mandatory preoperative nasogastric tube trials and evidence-based algorithms. The pathway eliminated unnecessary surgeries in 15 patients while improving care consistency and resource utilization.
Written by the GCMD Library team from the article.
Background
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.
Methods
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.
Results
We identified 332 patients who were referred for GT. Of these, 15 avoided placement. Concurrent fundoplication decreased postpathway (48% vs 22%, p