Standardized pathway for feeding tube placement reduces unnecessary surgery and improves value of care

Area of Science:

• Pediatric surgery
• Gastroenterology
• Healthcare management

Background:

• Children needing gastrostomy tubes (GT) incur high healthcare costs.
• Decisions regarding concurrent fundoplication during GT surgery vary widely, potentially increasing surgical morbidity.
• A hospital-wide standardized pathway for GT placement was implemented to address these issues.

Purpose of the Study:

• To evaluate the impact of a standardized pathway on gastrostomy tube placement and concurrent fundoplication rates.
• To assess changes in postoperative outcomes, including length of stay and emergency department visits.
• To determine the effect of the pathway on healthcare resource utilization.

Main Methods:

• A prospective study comparing outcomes before and after pathway implementation (2015-2018).
• The pathway included a mandatory nasogastric feeding tube trial, defined medical home, standardized postoperative orders, and an algorithm for fundoplication decisions.
• Data on concurrent fundoplication rates, length of stay, and emergency department visits were analyzed.

Main Results:

• Concurrent fundoplication rates decreased significantly post-pathway (48% to 22%).
• Patients were 3.5 times less likely to undergo concurrent fundoplication after pathway implementation, even after adjusting for reflux and cardiac disease.
• Emergency department visits decreased from 46% to 27%, and postoperative length of stay was reduced.

Conclusions:

• The standardized pathway effectively prevented unnecessary gastrostomy tube placements and fundoplications.
• Implementation led to significant reductions in postoperative length of stay and emergency department visits.
• This standardized approach optimizes resource utilization and improves patient outcomes in pediatric gastrostomy tube care.