The Effect of Standardized Discharge Instructions After Gastrostomy Tube Placement on Postoperative Hospital Utilization
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In brief
In brief
Retrospective study of 197 pediatric gastrostomy tube patients found that standardized discharge instructions significantly reduced emergency department visits, office visits, and phone calls at 30 days and 1 year postoperatively. While total hospital utilization at 30 days showed no difference, the protocol demonstrated sustained reduction in multiple healthcare touchpoints.
Written by the GCMD Library team from the article.
Abstract
Background/Purpose
Gastrostomy tube (GT) placement is a common pediatric procedure with high postoperative resource utilization. We aimed to determine if standardized discharge instructions (SDI) reduced healthcare utilization rates.
Methods
We performed a retrospective cohort study comparing postoperative hospital utilization of patients who underwent initial GT placement pre- and post-SDI protocol implementation from 2014-2019. Statistical analyses included Chi-square tests, multivariable adjusted logistic regression, adjusted Cox proportion hazard regression, and adjusted Poisson regression models when appropriate.
Results
197 patients were included, 102 (51.8%) before and 95 (48.2%) after protocol implementation. On primary analysis, SDI patients did not have significantly different total postoperative hospital utilization events at 30-days (48.0% vs. 38.9%, p=0.25). On secondary analysis, SDI patients had lower rates of ED (8.4% vs. 19.6%, p = 0.026) and office visits (11.6% vs. 25.5%, p=0.017) at 30-days. Non-SDIs patients had greater odds of ED visits (OR2.7, 95%CI 1.3-5.9, p=0.01), office visits (OR3.7, 95%CI 1.7-8.1, p=0.001) and phone calls (OR2.6, 95%CI 1.2-5.7, p=0.016) at 1-year. The adjusted hazard ratio was 2.0 (95%CI 1.4-3.0, p<0.001). Incident rate ratio were 1.8 (95%CI 1.2-2.5, p=0.002) at 30-days and 1.9 (95%CI 1.5-2.4, p<0.001) at 1-year post-discharge.
Conclusions
SDIs post-GT placement may reduce multiple aspects of postoperative hospital utilization.