Improving Pediatric Patient Readiness for Gastrostomy Placement via Caregiver's Preconsult Involvement

Abstract

Introduction Patients and families referred for gastrostomy tube placement were rarely informed or prepared for the presurgical evaluations required to schedule surgery. These requirements are embedded in a Gastrostomy Readiness Checklist (GRC) that must be completed before scheduling surgery. The GRC was intended to be initiated by the referring provider, yet this was rarely done. As a result, registered nurses (RNs) assumed responsibility for the GRC. Families were often dissatisfied with the need for additional appointments and delayed surgery scheduling. The purpose of this quality improvement project was to increase readiness for surgery by better preparing families for the consult, while decreasing RN involvement in the GRC. Methods The GRC was placed on a Web-based platform that schedulers asked parents to complete before the consult. A standard process was created for RNs to obtain orders for presurgical evaluations so all appointments could be scheduled on the same day. Results GRC initiation increased 38% by transitioning it to caregivers. The need for additional presurgical visits decreased 62%. The ability to immediately schedule surgery increased 36%. RN clinic preparation time decreased by 28%. Discussion Implementation of a standard process for coordinating presurgical evaluations improved readiness to schedule surgery at the time of consult and reduced the need for additional clinic visits. Giving families advanced access to the GRC increased knowledge of gastrostomy placement requirements. RNs' satisfaction increased with more time available for other patient care priorities. There is an opportunity to improve GRC initiation by families through better training of the scheduling team.

Nurse Practitioner-Managed Clinic Reduces Emergency Department Visits for Parents of Children With Problematic Gastrostomy Tubes

“…For surgical patients, NPs are frequently utilized for preoperative education and may be better than physicians at addressing the psychosocial aspects of preparing for surgery (Frisch, Johnson, Timmons, & Weatherford, 2010). A recent study at Seattle Children's Hospital found that an Registered Nurse-driven protocol to assist parents in completing a preoperative safety checklist before scheduling G-tube placement increased readiness for surgery and reduced the number of clinic visits needed before scheduling surgery (Albin & McCormick, 2019). In G-tube patients, a nursing-run preoperative educational session may reduce postoperative ED visits (Barry et al, 2018).…”