Emergency department utilization following pediatric gastrostomy tube placement is driven by a small cohort of patients

Ruffolo, Luis I.; McGuire, Anna L.; Calderon, Thais; Wolcott, Kori; Levatino, Elizabeth; Martin, Heather; Foito, Theresa; Pulhamus, Marsha; Wakeman, Derek

doi:10.1016/j.jpedsurg.2020.07.016

Cited by 14 publications

(5 citation statements)

References 16 publications

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Section: Discussionmentioning

confidence: 99%

“…28 Another recent study showed that a quarter of the patients are responsible for the majority (82%) of ER visits, with non-Caucasian patients at higher risk, highlighting the need for a larger cohort or prospective database of patients to identify further characteristics of high-risk patients and to begin to mitigate risk and disparities. 29 In the face of rising health care costs, the use of resources and financial strain on both the family and the health system should be considered. One study evaluating hospital resource utilization found a decrease in utilization after implementation of a standardized feeding device placement pathway.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Complications and Weight Outcomes in Pediatric Cerebral Palsy Patients With Gastrostomy Tubes

Jadi

Hyder

Ormaza

et al. 2021

The American Surgeon™

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Background Feeding difficulties are common in children with cerebral palsy (CP). The goal of this study was to examine pediatric CP patients undergoing gastrostomy tube (G tube) placement and assess the association between patient characteristics and weight after 3 months, 6 months, and 1 year. Methods This was a retrospective study of all pediatric patients with CP who received a G tube placement between April 2014 and December 2017 at a single institution. Bivariate analysis was used to examine association between patient characteristics and the primary outcome of improvement in weight Z score at 3, 6, and 12 months. Results Of 63 patients who received a G tube, 81% had an increase in Z score at 3 months, 44% at 6 months, and 64% at 12 months. By 12 months, factors associated with a positive Z score change included moderate and severe malnutrition, lack of prior G tube, and fewer comorbidities. The majority (69.8%) of patients experienced complications. Seven (11%) patients died, with only 1 death related to G tube placement. Discussion The use of G tubes in CP patients resulted in an increase in an improvement in nutritional status for the majority of patients over the course of a year. Although most complications were minor, patients had a high complication rate and frequently visited the emergency department, highlighting the need for standardized education and follow-up among this patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of Complications and Weight Outcomes in Pediatric Cerebral Palsy Patients With Gastrostomy Tubes

Jadi

Hyder

Ormaza

et al. 2021

The American Surgeon™

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“…In our series, there were cases that did not allow this type of approach, so we preferred to place a gastrojejunostomy tube, and then wait for the improvement of the general conditions to correct gastroesophageal reflux, as recommended by other authors [12]. In some cases, the general conditions could worsen over time and create difficulties in managing the gastrostomy tube [13][14][15].…”

Section: Discussionmentioning

confidence: 97%

What Is the Correct Way to Manage Children Requiring Gastrostomy? Single Center Experience

Noviello

Romano

Bindi

et al. 2021

Gastroenterology Insights

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Children with complex medical issues often present different comorbidities that cause feeding difficulties. Gastrostomy is often helpful, and should be performed when nutritional supplementation is necessary for longer than 6 weeks. Recently, different techniques have been used for gastrostomy in children. The authors report on their experiences regarding the diagnostic and therapeutic management of children requiring gastrostomy. All patients managed in the last 10 years were reviewed, retrospectively. Everyone underwent investigation to exclude gastroesophageal reflux disease (GERD). A total of 148 patients: 111 cases (75%) were neurologically impaired patients, 18 (12%) had complex heart disease, 10 (6%) had metabolic diseases, 4 (3%) had fibrosis cystic, 4 (3%) had muscle disease, and one had chromosomopathy. After investigation, 49 patients had GERD. PEG was performed in 101 cases (68%), laparo-assisted gastrostomy was performed in 44 cases (29.7%), open gastrostomy was performed in three cases. At follow-up, all patients reported weight gain, but 13 cases had major complications. Currently, the surgeon has the possibility of choosing between several safe techniques for gastrostomy. In our experience, PEG is the most useful technique for patients without GERD, while a laparo-assisted technique is better for patients who require laparoscopic fundoplication.

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“…First, a phone number is now provided to caregivers explicitly to call before an ED visit for a tube dislodgment, with a goal of diverting some of these visits. From 2011 to 2018, only 8% of patients coming to our ED for a G-tube-related problem called the clinic before presenting to the ED (Ruffolo, McGuire, et al, 2021). When data began to be collected for this project in January 2017 to the conclusion of the intervention in October 2018, that number increased to 10.3%.…”

Section: Discussionmentioning

confidence: 99%

“…Severe complications range from 1% to 17%, depending on technique used, and minor complications including granulation tissue can occur in up to 68% of all cases (Arca et al, 2017;Correa et al, 2014;Goldberg et al, 2010). Several institutions have tracked emergency room visits 30 days after patient discharge from the hospital for G-tube-related problems and have found the revisit rate ranged from 8.6% to 20% (Cameron et al, 2020;Ruffolo, McGuire, et al, 2021;Saavedra et al, 2009). Complications from G-tube placement put a significant burden on the health care system and are stressful for the patient and family.…”

Section: Introductionmentioning

confidence: 99%

An Interdisciplinary Intervention to Reduce Gastrostomy-tube-related Pediatric Emergency Department Visits

Erlick

Pulhamus

Schriefer

et al. 2024

Journal of Pediatric Surgical Nursing

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Introduction: Gastrostomy tube (G-tube)-related problems, including dislodgements, are a frequent cause for emergency department (ED) visits in pediatric patients. We aimed to reduce G-tube-related ED visits at our children's hospital. Methods: An interprofessional team was formed including a family advisor, nurse practitioners, discharge coordinators, a pediatric surgeon, surgical residents, nurses, and quality improvement coaches. A number of interventions were put into place intended to improve caregiver preparation for G-tube placement, improved communication during the hospitalization, and postoperative interventions, including a new family education pathway and mechanical barriers to prevent tube dislodgment. Results: Overall, tube dislodgment accounted for 64% of G-tube-related ED visits: 14% in tubes less than 3 months from insertion and 86% in tubes older than 3 months. Our rate of ED visits for G-tube dislodgement had an initial baseline of nine visits per month. In the 3 years after the intervention, ED visits decreased from a median of 9.5 per month to 8 per month. Discussion: An interprofessional team implemented a quality improvement project that reduced G-tube-related ED visits in pediatric patients. Further efforts are needed to better understand the contributing drivers of G-tube-related ED visits and ways to minimize these events. Grant monies have been obtained from URMC Quality Institute and Vermont Oxford Network NICU Follow Thru Health Equity to continue our family-led quality improvement efforts.

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Emergency department utilization following pediatric gastrostomy tube placement is driven by a small cohort of patients

Cited by 14 publications

References 16 publications

Evaluation of Complications and Weight Outcomes in Pediatric Cerebral Palsy Patients With Gastrostomy Tubes

Evaluation of Complications and Weight Outcomes in Pediatric Cerebral Palsy Patients With Gastrostomy Tubes

What Is the Correct Way to Manage Children Requiring Gastrostomy? Single Center Experience

An Interdisciplinary Intervention to Reduce Gastrostomy-tube-related Pediatric Emergency Department Visits

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