Improving Inpatient Gastroenterology Percutaneous Endoscopic Gastrostomy (PEG) Tube Referrals and Outcomes

Healthcare providers must understand indications and contraindications for percutaneous endoscopic gastrostomy (PEG) tube placement. Appropriate patient selection necessitates interdisciplinary collaboration and patient-centered decision-making. Guidelines recommend preprocedural checklists for meticulous evaluation. This quality improvement initiative established a standardized workflow using a novel checklist for proper PEG tube placement consultation. The authors aimed to improve the PEG tube consult process by achieving ≥ 50% utilization of a standardized consult checklist within one year.

A novel electronic health record (EHR)-based checklist was employed to guide primary teams in patient optimization before consulting gastroenterology for PEG tubes. Teams received comprehensive education on indications, contraindications, techniques, and risks. Pre- (June 1, 2021-July 31, 2022) and postintervention (September 1, 2022-August 31, 2023) cohorts were compared. Outcome measures included checklist utilization, number of days between the initial consultation and PEG tube placement, reasons for delays in PEG tube placement, patient selection, total hospital length of stay (LOS), 30-day all-cause mortality, and complications related to PEG tube placement.

Following implementation, the checklist was used in 69.2% of cases. The number of patients able to tolerate oral intake at discharge decreased significantly (24.6% pre- vs. 10.8% postintervention with checklist, p = 0.014), as did the mean total hospital LOS (64.18 ± 102.4 days pre- vs. 48.52 ± 27.02 days postintervention, p = 0.01). Time from consult to placement, 30-day complication rate, and all-cause mortality also decreased postintervention. However, these findings were not statistically significant.

This intervention achieved high adherence within one year and was associated with improved patient selection. These findings may provide a framework for other health systems seeking to implement similar initiatives, thereby supporting effective preconsultation screening for PEG tube placement.