Pediatric Gastrostomy Tube Placement: Lessons Learned from High-performing Institutions through Structured Interviews

Loren Berman, Carla Hronek, Mehul V Raval, Marybeth L Browne, Charles L Snyder, Kurt F Heiss, Shawn J Rangel, Adam B Goldin, David H Rothstein, Loren Berman, Carla Hronek, Mehul V Raval, Marybeth L Browne, Charles L Snyder, Kurt F Heiss, Shawn J Rangel, Adam B Goldin, David H Rothstein

Abstract

Introduction: Gastrostomy tube (GT) placement is one of the most common operations performed in children, and it is plagued by high complication rates. Previous studies have shown variation in readmission and emergency room visit rates across different children's hospitals, with both low and high outliers. There is an opportunity to learn how to optimize outcomes by identifying practices at high-performing institutions.

Methods: Surgeons and nurses routinely involved in GT care at 8 high-performing pediatric centers were identified. We conducted structured interviews focusing on the approach to GT education, technical aspects of GT placement, and postoperative management. Summary statistics were performed on quantitative data, and the open-ended responses were analyzed by 2 independent reviewers using content analysis.

Results: Several common practices among high-performing centers were identified (standardized approach to education, availability by phone and in clinic to manage GT-related issues, and empowering families to feel confident with troubleshooting and dealing with GT problems). There was substantial variation in operative technique and postoperative care. The participants expressed that technical aspects of operative placement and postoperative management of feedings and common complications are not as important as education, availability, and empowerment in optimizing outcomes.

Conclusions: We have identified common themes among pediatric centers with favorable outcomes after GT placement. Identifying which components of GT care are associated with optimal outcomes is critical to our understanding of current practice and may help identify opportunities to improve care quality.

Figures

Fig. 1.
Fig. 1.
Themes from qualitative data analysis.

References

    1. HCUP Kids’ Inpatient Database (KID). Healthcare cost and utilization project (HCUP). 2009. Available at: . Accessed August 1, 2016.
    1. Goldin AB, Heiss KF, Hall M, et al. Emergency department visits and readmissions among children after gastrostomy tube placement. J Pediatr. 2016;174:139–145.
    1. Saavedra H, Losek JD, Shanley L, et al. Gastrostomy tube-related complaints in the pediatric emergency department: identifying opportunities for improvement. Pediatr Emerg Care. 2009;25:728–732.
    1. Correa JA, Fallon SC, Murphy KM, et al. Resource utilization after gastrostomy tube placement: defining areas of improvement for future quality improvement projects. J Pediatr Surg. 2014;49:1598–1601.
    1. Bardach NS, Vittinghoff E, Asteria-Penaloza R, et al. Measuring hospital quality using pediatric readmission and revisit rates. Pediatrics. 2013;132:429–436.
    1. Richards MK, Yanez D, Goldin AB, et al. Factors associated with 30-day unplanned pediatric surgical readmission. Am J Surg. 2016;212:426–432.
    1. Berry JG, Toomey SL, Zaslavsky AM, et al. Pediatric readmission prevalence and variability across hospitals. JAMA. 2013;309:372–380.
    1. Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111–148, 124 Stat. (2010).119
    1. Glaser BG, Strauss AL.The Discovery of Grounded Theory: Strategies for Qualitative Research. 1967Chicago, Ill.: Aldine;
    1. Bradley EH, Curry LA, Devers KJ.Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res. 2007;42:1758–1772.
    1. Creswell JW, Clark VLP.Designing and Conducting Mixed Methods Research. 2006London: Sage;
    1. Baker L, Beres AL, Baird R.A systematic review and meta-analysis of gastrostomy insertion techniques in children. J Pediatr Surg. 2015;50:718–725.
    1. Baker L, Emil S, Baird R.A comparison of techniques for laparoscopic gastrostomy placement in children. J Surg Res. 2013;184:392–396.
    1. Kirk L, Shelley A, Battles M, et al. Educating parents on gastrostomy devices: necessary components to achieve success. J Pediatr Nurs. 2014;29:457–465.
    1. Chaplen C.Parents’ views of caring for children with gastrostomies. Br J Nurs. 1997;6:34–38.
    1. Schweitzer M, Aucoin J, Docherty SL, Rice HE, Thompson J, Sullivan DT.Evaluation of a discharge education protocol for pediatric patients with gastrostomy tubes. J Pediatr Health Care. 2014;28:420–428.
    1. Franco SM, Mitchell CK, Buzon RM.Primary care physician access and gatekeeping: a key to reducing emergency department use. Clin Pediatr. 1997;36:63–68.
    1. Lowe RA, Localio AR, Schwarz DF, et al. Association between primary care practice characteristics and emergency department use in a medicaid managed care organization. Med Care. 2005;43:792–800.
    1. Anderson RM, Funnell MM.Patient empowerment: myths and misconceptions. Patient Educ Couns. 2010;79:277–282.
    1. Brenner M, Larkin PJ, Hilliard C, Cawley D, Howlin F, Connolly M.Parents’ perspectives of the transition to home when a child has complex technological health care needs. Int J Integr Care. 2015;15:e035.

Source: PubMed

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