A Quality Improvement Initiative to Reduce Gastrostomy Tube Placement in Aspirating Patients

Area of Science:

• Pediatric Gastroenterology
• Clinical Quality Improvement
• Swallowing Disorders

Background:

• Oropharyngeal dysphagia and aspiration are common in pediatric patients, leading to varied clinical practices for feeding tube management.
• Current approaches to oral feeding versus gastrostomy tube placement in children with dysphagia show significant practice variation.
• Standardizing care for pediatric dysphagia is crucial to optimize patient outcomes and resource utilization.

Purpose of the Study:

• To implement an evidence-based guideline (EBG) to standardize the management of pediatric oropharyngeal dysphagia and aspiration.
• To reduce the rate of gastrostomy tube placement in children diagnosed with aspiration.
• To evaluate the impact of the EBG on oral feeding rates and long-term patient outcomes.

Main Methods:

• A quality improvement intervention was implemented between January 2014 and December 2018, focusing on patients ≤2 years with respiratory symptoms and aspiration on videofluoroscopic swallow study (VFSS).
• An EBG was developed and utilized by gastroenterologists to guide clinical decision-making for feeding interventions.
• The primary outcome was a 10% decrease in gastrostomy tube placement within 1 year of EBG initiation, with balancing measures including hospital readmissions and emergency department (ED) visits.

Main Results:

• A total of 1668 patients with aspiration or penetration on VFSS were included in the analysis.
• Mean gastrostomy tube placement decreased from 10.9% at baseline to 5.2% within 1 year of EBG implementation, a 50% reduction.
• This reduction was sustained over 3 years, with no significant changes observed in hospital readmissions or ED visits.

Conclusions:

• Implementation of an evidence-based guideline significantly reduced gastrostomy tube placement in pediatric patients with oropharyngeal dysphagia and aspiration.
• The standardized approach improved care without adversely affecting patient safety, as indicated by stable readmission and ED visit rates.
• This study demonstrates the effectiveness of an EBG in optimizing feeding strategies and reducing invasive interventions for children with swallowing difficulties.