Improving Pediatric Patient Readiness for Gastrostomy Placement via Caregiver's Preconsult Involvement

Inside Out Medicine implemented a patient flow model to increase patient readiness for surgery and improve efficiency for clinical staff. The new model decreased the need for additional presurgical visits by 62%. Patient/family readiness to schedule surgery immediately following the consult increased 36%. Nurse clinic preparation time decreased by 28%.

Journal of Pediatric Surgical Nursing. 2019;8(4):91-96.
doi: 10.1097/JPS.0000000000000223.

Dawn Albin, BSN, RN, CPN, and Christa McCormick, BSN, RN, CPN

• Affiliations

  1. Dawn Albin, BSN, RN, CPN Department of General Surgery, Seattle Children's Hospital, Seattle, WA.

  2. Christa McCormick, BSN, RN, CPN Department of Plastic Surgery, Seattle Children's Hospital, Seattle, WA.

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ABSTRACT

• Background

  Patients and families referred for gastrostomy tube placement were rarely informed or prepared for the presurgical evaluations required to schedule surgery. These requirements are embedded in a Gastrostomy Readiness Checklist (GRC) that must be completed before scheduling surgery. The GRC was intended to be initiated by the referring provider, yet this was rarely done. As a result, registered nurses (RNs) assumed responsibility for the GRC. Families were often dissatisfied with the need for additional appointments and delayed surgery scheduling. The purpose of this quality improvement project was to increase readiness for surgery by better preparing families for the consult, while decreasing RN involvement in the GRC.

• Methods

  The GRC was placed on a Web-based platform that schedulers asked parents to complete before the consult. A standard process was created for RNs to obtain orders for presurgical evaluations so all appointments could be scheduled on the same day.

• Results

  GRC initiation increased 38% by transitioning it to caregivers. The need for additional presurgical visits decreased 62%. The ability to immediately schedule surgery increased 36%. RN clinic preparation time decreased by 28%.

• Discussion

  Implementation of a standard process for coordinating presurgical evaluations improved readiness to schedule surgery at the time of consult and reduced the need for additional clinic visits. Giving families advanced access to the GRC increased knowledge of gastrostomy placement requirements. RNs' satisfaction increased with more time available for other patient care priorities. There is an opportunity to improve GRC initiation by families through better training of the scheduling team.

“The Gastrostomy Readiness Checklist [GRC] was placed on a web-based platform [Inside Out Care] that schedulers asked parents to complete before the consult. A standard process was created for RNs to obtain orders for presurgical evaluations so all appointments could be scheduled on the same day.

GRC initiation increased 38% by transitioning it to caregivers. The need for additional presurgical visits decreased 62%. The ability to immediately schedule surgery increased 36%. RN clinic preparation time decreased by 28%.”