Improving Goal Feeding and Discharge Time in Pediatrics After G-Tube Placement: A QI Project

Abstract

BACKGROUND: Gastrostomy tube (GT) placement is a common pediatric surgical procedure. Prior to implementation of a standardized clinical practice guideline (CPG), there was considerable practitioner variability in postoperative care and discharge preparation of this patient population, resulting in prolonged time to full feeding and postoperative length of stay (PLOS). This study evaluated time to full feeding and PLOS comparing pre- and post-GT CPG implementation. We hypothesized CPG use would decrease time to full feeding and PLOS. METHODS: A multidisciplinary pediatric surgery quality improvement (QI) team created a CPG using best practice evidence accounting for institutional workflow. The CPG implemented a standardized postoperative feeding advancement pathway, structured caregiver education, and ordering of home equipment. We conducted a QI initiative evaluated using statistical process control methodology to assess changes in outcomes over time following implementation of a CPG. RESULTS: The pre-implementation cohort (N = 82) showed median time to full feeds of 25.8 hours (IQR: 14.3), median PLOS of 30.6 hours (IQR: 23.7), 20 (24%) patients with postoperative emesis, and 19 (23%) with postoperative ED visits. The post-implementation cohort showed median time to full feeds of 19.3 hours (IQR: 6.6), median PLOS of 27.1 hours (IQR: 4.7), 12 (14%) patients with postoperative emesis, and 19 (23%) with ED visits. Maintenance cohort showed sustained change with additional PLOS improvement. CONCLUSIONS: Implementation of GT placement CPG was associated with a decreased time to full feeds and PLOS without adversely affecting emesis or ED visits. Collaborative CPGs can positively affect patient care.