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Staying put: A single institution quality improvement initiative to reduce early gastrostomy tube dislodgement in
Alexa G Turpin1, Molly Haislip1, Kristen Delin1
1Nemours Children's Health, Department of General Surgery, Wilmington, DE, United States.
Insights
Implementing standardized post-operative care and targeted education significantly reduced early gastrostomy tube dislodgement in children. This quality improvement initiative lowered dislodgement rates, improving patient outcomes and reducing healthcare utilization.
Area of Science:
- Pediatric Surgery
- Quality Improvement Science
- Patient Safety
Background:
- Early gastrostomy tube (GT) dislodgement is a common, preventable complication in pediatric surgery.
- This complication leads to increased morbidity, healthcare utilization, and the need for re-operation.
Purpose of the Study:
- To decrease the incidence of early GT dislodgement from 14.3% to 7% within 12 months.
- To implement a quality improvement initiative to reduce early GT dislodgements in pediatric patients.
Main Methods:
- A multidisciplinary team developed interventions including standardized post-operative dressings and comprehensive family/nursing education.
- A post-operative order set was created, and process measures tracked adherence to dressings and education completion.
- High-risk patients were identified and contacted post-operatively to reinforce education.
Main Results:
- 100% compliance with family education was achieved.
- Post-operative dressing compliance reached 100% after an initial lag.
- The early dislodgement rate decreased from 14.8% to 4.3% post-implementation.
Conclusions:
- Hospital-wide post-operative protocols, standardized dressings, and high-quality parent education are effective.
- Targeted interventions for high-risk patients further enhance the reduction of early GT dislodgement.
- These strategies can significantly decrease GT dislodgement rates and associated morbidity in children.
Purpose:
Gastrostomy tube (GT) placement is one of the most common surgical procedures performed in children. Early GT dislodgement is a potentially preventable complication associated with high morbidity, increased healthcare utilization, and need for early instrumentation or re-operation. This quality improvement initiative aimed to reduce the rate of early GT dislodgement from 14.3% to 7% within 12 months.
Methods:
After identifying a high rate of early GT dislodgements, a team of multidisciplinary stakeholders developed a quality improvement initiative to reduce early dislodgements, defined as any dislodgement within 60 days of surgery. The intervention included: 1) standardization of post-operative GT dressing; 2) robust family education focusing on common GT problems, GT dressings and securement, and instructions for management if dislodgement occurs; 3) nursing education and hands-on demonstration; and 4) creation of a post-operative order set, including the new dressing order and instructions to disconnect the extension tubing when not in use. Process measures included adherence to post-operative dressings and completion of family education. The outcome measure was GT dislodgement rate.
Results:
Since Go-Live, there has been 100% compliance with completion of family education. Compliance with standard post-operative dressing initially lagged, but has been 100% since February 2025, with the exception of October 2025. At 1.5 years post-implementation, the rate of early dislodgements was not trending in the desired direction, so we identified patients at higher risk for dislodgement based on demographic factors. All high-risk patients are contacted via telephone two weeks post-operatively to check in and reinforce family education. The rate of early dislodgement has decreased from 14.8% to 4.3%.
Conclusion:
Interventions including hospital-wide post-operative protocols, standardized dressings, high-quality parent education, and targeted efforts for high-risk patients can reduce rates of early GT dislodgement in children and related morbidity.
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