GJ Express: an improvement initiative to decrease sedation and anesthesia for gastrojejunostomy tube exchanges.

Area of Science:

• Pediatric Gastroenterology
• Quality Improvement Science
• Patient Safety

Background:

• Overuse of sedation and anesthesia for gastrojejunostomy tube (GJ) exchanges leads to delays, complications, resource waste, and poor patient experience.
• The hospital aimed to reduce sedation/anesthesia use for GJ tube exchanges from 78% to 20% within two years.

Purpose of the Study:

• To decrease the utilization of sedation and anesthesia during routine pediatric gastrojejunostomy tube exchanges.
• To improve patient safety and reduce healthcare costs associated with GJ tube procedures.

Main Methods:

• An interdisciplinary quality improvement team conducted a retrospective chart review and prospective time series analysis.
• The primary outcome measured was the percentage of pediatric patients receiving sedation or anesthesia for GJ tube exchanges.

Main Results:

• The median percentage of pediatric GJ tube exchanges performed with sedation or anesthesia decreased from 77.8% to 11.3%.
• Statistical process control p-charts demonstrated the sustained reduction over time.
• The majority of patients (76%) were covered by Medicaid, and reduced anesthesiologist billing did not negatively impact finances.

Conclusions:

• An interprofessional initiative involving patients, families, and pediatric-specific staff successfully reduced the overuse of sedation and anesthesia for GJ tube exchanges.
• This quality improvement work is highly relevant for institutions managing children with feeding issues requiring GJ tubes.
• The study highlights a critical issue with limited literature, offering a model for improved patient safety and cost reduction.