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Gastric Emptying Studies in Pediatrics: A Cincinnati Children's Hospital Experience
Joseph Joby MacLean1, Khalil El-Chammas2
1Nuclear Medicine Section, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and joseph.maclean@cchmc.org khalil.el-chammas@cchmc.org.
Insights
Standardizing gastric emptying studies with a consistent meal and 4-hour imaging protocol improves patient care. This nuclear medicine technique aids in diagnosing gastric emptying abnormalities.
Area of Science:
- Nuclear Medicine
- Gastroenterology
- Pediatric Imaging
Background:
- Gastric emptying studies are crucial for diagnosing gastrointestinal motility disorders.
- Varied methodologies exist nationwide, leading to inconsistencies in clinical practice.
- Standardization is needed to improve diagnostic accuracy and patient care.
Purpose of the Study:
- To implement and evaluate a standardized protocol for pediatric gastric emptying studies.
- To improve consistency in clinical practice for gastric emptying assessments.
- To optimize workflow and patient care in a high-volume nuclear medicine setting.
Main Methods:
- Adoption of adult standards for pediatric gastric emptying studies, including a standardized meal and 4-hour imaging.
- Modifications to scheduling templates, questionnaires, and electronic order sets.
- Empowerment of nuclear medicine technologists to make protocol deviations based on patient tolerance, with documentation.
Main Results:
- Successful implementation of a standardized protocol for pediatric gastric emptying studies.
- Demonstrated ability to accommodate high patient volumes through workflow optimization.
- Established a consistent approach to evaluating gastric emptying with solid, liquid, or mixed meals.
Conclusions:
- Protocol standardization and workflow optimization are essential for consistent patient care in gastric emptying studies.
- Standardized protocols, with documented deviations, enhance diagnostic value for gastroenterologists.
- The implemented protocol facilitates accurate diagnosis and treatment of gastric emptying abnormalities.
Abstract:
Gastric emptying studies are routinely performed in many nuclear medicine departments; however, there are many different techniques used to perform the procedure across the country. Creating consistency in clinical practice will aid gastroenterologists in diagnosing and treating illnesses associated with abnormalities related to gastric emptying. In 2017, Cincinnati Children's Hospital adopted adult standards for pediatric gastric emptying studies that included a standard meal along with imaging over the course of 4 h. Gastric emptying studies are the second-highest-volume examination performed in the nuclear medicine section at Cincinnati Children's Hospital. Accommodating this volume required changes in the scheduling template, scheduling questionnaire, and epic order sets, as well as identification of specific days and locations for gastric emptying studies. Both protocol standardization and workflow optimization are critically important in creating consistency in patient care. Gastric emptying can be evaluated with solid food, liquid food, or solid and liquid food simultaneously. The methodology of the study is initially determined by the ordering provider but may require special accommodations based on what the patient will tolerate. In coordination with the ordering and interpreting physicians, the nuclear medicine technologists at Cincinnati Children's Hospital have the decision-making ability to deviate from the provider's request as necessary, which helps expedite workflow and eliminates wasted time. Any deviation from the standardized protocol is documented by the nuclear medicine technologist and incorporated into the final report by the interpreting physician, as dietary information is meaningful to the ordering provider. Reference values associated with the standardized or modified protocol are also included in the final report.
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