Resource utilization after implementing a hospital-wide standardized feeding tube placement pathway

J Pediatr Surg. 2016 Oct;51(10):1674-9. doi: 10.1016/j.jpedsurg.2016.05.012. Epub 2016 Jun 2.

Morgan K Richards 1, Christopher I Li 2, Jeffrey L Foti 3, Michael G Leu 4, Ghassan T Wahbeh 5, Dennis Shaw 6, Arlene K Libby 7, Lilah Melzer 8, Adam B Goldin 9

• Affiliations

  1. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States; Department of Surgery, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, Washington, 98195, United States. Electronic address: morgan.richards@gmail.com.

  2. Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, Washington, 98109, United States. Electronic address: cili@fredhutch.org.

  3. Division of General Pediatrics and Hospital Medicine, Department of Pediatrics, University of Washington, 1959 NE Pacific Street, Seattle, Washington, 98195, United States. Electronic address: jeffrey.foti@seattlechildrens.org.

  4. Division of General Pediatrics and Hospital Medicine, Department of Pediatrics, University of Washington, 1959 NE Pacific Street, Seattle, Washington, 98195, United States; Department of Biomedical Informatics and Medical Education, University of Washington, 1959 NE Pacific Street, Seattle, Washington, 98195, United States. Electronic address: michael.leu@seattlechildrens.org.

  5. Division of Gastroenterology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States. Electronic address: ghassan.wahbeh@seattlechildrens.org.

  6. Division of Interventional Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States. Electronic address: dennis.shaw@seattlechildrens.org.

  7. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States. Electronic address: arlene.libby@seattlechildrens.org.

  8. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States. Electronic address: melzer.lilah@gmail.com.

  9. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States. Electronic address: adam.goldin@seattlechildrens.org.

Inside Out Medicine implemented a patient flow model as part of a hospital-wide standardized pathway for feeding device placement. This study compares hospital resource utilization before and after pathway implementation. Prior to implementation, 174/298 (58.4%) patients required additional hospital resource utilization compared to 60/143 (42.0%), corresponding to a 38% reduced risk of a subsequent feeding tube related event.

---

ABSTRACT

• Background

  Children requiring gastrostomy/gastrojejunostomy tubes (GT/GJ) are heterogeneous and medically complex patients with high resource utilization. We created and implemented a hospital-wide standardized pathway for feeding device placement. This study compares hospital resource utilization before and after pathway implementation.

• Methods

  We performed a retrospective cohort study comparing outcomes through one year of follow-up for consecutive groups of children undergoing GT/GJ placement prepathway (n=298, 1/1/2010–12/31/2011) and postpathway (n=140, 6/1/2013–7/31/2014) implementation. We determined the change in the rate of hospital resource utilization events and time to first event.

• Results

  Prior to implementation, 145 (48.7%) devices were placed surgically, 113 (37.9%) endoscopically and 40 (13.4%) using image guidance. After implementation, 102 (72.9%) were placed surgically, 23 (16.4%) endoscopically and 15 (10.7%) using image guidance. Prior to implementation, 174/298 (58.4%) patients required additional hospital resource utilization compared to 60/143 (42.0%) corresponding to a multivariate adjusted 38% reduced risk of a subsequent feeding tube related event.

• Conclusions

  Care of tube-feeding dependent patients is spread among multiple specialists leading to variability in the preoperative workup, intraoperative technique and postoperative care. Our study shows an association between implementation of a standardized pathway and a decrease in hospital resource utilization.

“Children requiring gastrostomy/gastrojejunostomy tubes (GT/GJ) are heterogeneous and medically complex patients with high resource utilization. We created and implemented a hospital-wide standardized pathway for feeding device placement. This study compares hospital resource utilization before and after pathway implementation.”