title: A Quality Improvement Initiative to Reduce Catheter Exchange Rates for Fluoroscopically Guided Gastrostomy Tubes.
abstract: OBJECTIVE
  To evaluate the effectiveness of a data-driven quality improvement initiative to reduce catheter exchange rates.
  
  
  METHODS
  A single-institution retrospective analysis of all percutaneous radiologic gastrostomy (PRG) placement and replacement procedures between January 2010 and July 2015 was conducted. A statistical model predicting the risk for catheter exchange for any reason and exchanges specifically for tube malfunction was created; a quality improvement plan to reduce catheter exchanges was designed and implemented in June 2014. The outcomes for subsequent PRG procedures from July 2014 through March 2015 were followed until July 2015.
  
  
  RESULTS
  Between 2010 and June 2014, 1,144 primary PRG procedures and 442 replacement procedures were performed in 1,112 patients. Of the 442 exchange procedures, 289 were "rescue" procedures secondary to catheter malfunction. A quality improvement plan was implemented in June 2014 that encouraged primary gastrojejunostomy catheter and balloon-retained PRG catheter placement and placement of skin sutures in patients considered high risk for catheter dislodgment. From July 2014 through March 2015, 229 PRG catheters were placed, and 71 exchange procedures were performed through July 2015. There was a statistically significant decrease in the number of rescue exchanges performed secondary to catheter malfunction (P = .036).
  
  
  CONCLUSIONS
  Procedural and patient-specific risk factors for PRG complications were identified, and a statistical model to predict rates of minor complications was created. These findings were used to implement a quality improvement program that resulted in a decrease in PRG exchanges secondary to catheter malfunction.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 290, 55 Fruit Street, Boston, MA 02114. Electronic address: rsheth@partners.org.
authors.forename: Rahul A
authors.initials: RA
authors.lastname: Sheth
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 290, 55 Fruit Street, Boston, MA 02114.
authors.forename: Brian
authors.initials: B
authors.lastname: Koottappillil
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 290, 55 Fruit Street, Boston, MA 02114.
authors.forename: Avinash
authors.initials: A
authors.lastname: Kambadakone
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 290, 55 Fruit Street, Boston, MA 02114.
authors.forename: Suvranu
authors.initials: S
authors.lastname: Ganguli
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 290, 55 Fruit Street, Boston, MA 02114.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Thabet
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 290, 55 Fruit Street, Boston, MA 02114.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mueller
mesh_terms: D020878:Device Removal / Q000706:statistics & numerical data*; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy; D005774:Gastrostomy / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D058996:Quality Improvement; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors