title: Pediatric Gastrojejunostomy Tube Replacement: Effects of Communication on the Need for After-Hours Procedures.
abstract: The aim of the study was to determine whether embedding into the radiology report a patient-specific plan in the event of gastrojejunostomy (GJ) tube dysfunction reduces the need for after-hours utilization of pediatric interventional radiology resources for the replacement of GJ tubes.
  
  
  
  This is a Health Insurance Portability and Accountability Act compliant, institutional review board-approved retrospective repeated cross-sectional study of patients requiring after-hours (5 PM-7 AM) or weekend (Saturday and Sunday) GJ tube replacement at a dedicated children's hospital, before and after the inclusion of a patient-specific plan in the radiology report as part of the electronic medical record.
  
  
  
  During a 6-month period before the inclusion of a patient-specific plan, there were 242 total GJ tube changes performed by the pediatric interventional radiology service under image guidance. Twenty-six (10.7%) of these procedures were performed outside of standard operating hours at the request of the emergency department (ED) (6/26), inpatient service (8/26), or patient/caregiver (12/26). Of the 8 inpatients, 3 were admitted from the ED for the sole purpose of tube replacement. Data were again collected for 6 months following inclusion of a patient-specific plan during the same seasonal period of the following year. During this period, 240 total image-guided changes were performed. Fifteen (6.2%) were performed outside of standard operating hours at the request of the ED (2/15), inpatient service (4/15), or patient/caregiver (9/15). No patients were admitted for GJ tube replacement procedures following implementation of the enhanced reporting policy. These data indicate a trend toward reduced after-hours resource utilization for GJ tube replacement requests by the ED (23.1%-13.3%), inpatient service (30.8%-26.7%), and all patients (14.7%-11%). Fewer after-hours GJ tube changes reduced cost by proportionately reducing hourly compensation for interventional radiology nurses and technicians.
  
  
  
  Our single-center data suggest that the inclusion of patient-specific recommendations at the end of each radiology GJ tube procedure note, generated in collaboration with the feeding service or primary medical provider, reduces off-hour resource utilization in patients who could otherwise have their tubes replaced during standard operating hours with image guidance. Avoidance of tube-related admissions is likely the greatest source of cost savings, followed by lower radiology technical support costs. Cost savings related to improved ED workflow and reduced patient/family anxiety are difficult to quantify, but likely significant. Future studies should be designed to quantify these savings and to assess the effect of this intervention on patient/caregiver satisfaction.
authors.affiliation: *Department of Radiology, Medical College of Wisconsin Affiliated Hospitals†Department of Radiology, Children's Hospital of Wisconsin‡Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Sharafinski
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sehnert
authors.forename: David
authors.initials: D
authors.lastname: Moe
authors.forename: Liyun
authors.initials: L
authors.lastname: Zhang
authors.forename: Pippa
authors.initials: P
authors.lastname: Simpson
authors.forename: Nghia J
authors.initials: NJ
authors.lastname: Vo
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011785:Quality Assurance, Health Care / Q000379:methods*; D011872:Radiology Department, Hospital / Q000458:organization & administration*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric