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Implementation of a gastrostomy care bundle reduces dislodgements and length of stay

Luis I Ruffolo1, Marsha Pulhamus1, Theresa Foito1

  • 1University of Rochester, Department of Surgery, Division of Pediatric Surgery, Rochester, NY, USA.

Journal of Pediatric Surgery
|November 10, 2020
PubMed

Insights

Implementing a care bundle significantly reduced pediatric gastrostomy tube dislodgements by 47%, improving patient outcomes and reducing hospital stays. This quality improvement initiative enhanced patient care and resource utilization.

Area of Science:

  • Pediatric surgery
  • Quality improvement science
  • Healthcare resource utilization

Background:

  • Pediatric gastrostomy tubes (G-tubes) are linked to significant healthcare resource use.
  • G-tube dislodgement can lead to serious complications like tract disruption and abdominal sepsis.

Purpose of the Study:

  • To reduce early G-tube dislodgement by 25% through targeted interventions.
  • To improve patient outcomes and healthcare value following pediatric gastrostomy tube insertion.

Main Methods:

  • An interdisciplinary team identified key drivers of G-tube dislodgement.
  • A G-tube care bundle was implemented in 2018.
  • Rates of dislodgement within 90 days, length of stay, and bundle compliance were tracked and compared pre- and post-implementation.

Main Results:

  • G-tube dislodgements decreased by 47% (from 43% to 19% per tube inserted).
  • Significant reductions were observed in both inpatient (14% to 1.5%) and outpatient (29% to 18%) settings.
  • Median length of stay decreased from 15.3 to 7.1 days, and bundle compliance exceeded 75% within a year.

Conclusions:

  • Quality improvement science methodology, applied by an interdisciplinary team, effectively reduces G-tube dislodgement.
  • The implemented care bundle significantly improved value and patient outcomes after pediatric gastrostomy tube insertion.
Abstract

Keywords:
Care standardizationDislodgementGastrostomyPediatricQuality

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