Resource utilization after implementing a hospital-wide standardized feeding tube placement pathway.
OBJECTIVE
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.
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.
Morgan K
MK
Richards
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, Washington, 98109, United States. Electronic address: cili@fredhutch.org.
Christopher I
CI
Li
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.
Jeffrey L
JL
Foti
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.
Michael G
MG
Leu
Division of Gastroenterology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States. Electronic address: ghassan.wahbeh@seattlechildrens.org.
Ghassan T
GT
Wahbeh
Division of Interventional Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States. Electronic address: dennis.shaw@seattlechildrens.org.
Dennis
D
Shaw
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.
Arlene K
AK
Libby
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.
Lilah
L
Melzer
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.
Adam B
AB
Goldin
D002675:Child, Preschool; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation; D006295:Health Resources / Q000706:statistics & numerical data*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal / Q000295:instrumentation; D008297:Male; D011182:Postoperative Care / Q000379:methods*; D058996:Quality Improvement; D012189:Retrospective Studies
Checklists; Continuous quality improvement; Gastrostomy; Health care quality improvement; Hospital resource utilization; Standards of care