Pediatric Resident Elizabeth Nichols Birmingham, Alabama, United States
Background: Pediatric patients with gastrostomy tubes (GT) experience a multitude of frequent complications that may end in a visit to the emergency department. These patients often times experience extended lengths of stay (LOS). With these frequent and extended visits, these patients have an increased risk of contracting illnesses within the ED, experience an additional number of tests and procedures, and additional economic and time burden. At our tertiary medical center on initial retrospective chart review, patients presenting for GT replacement had a statistically significant increase in LOS when receiving a surgery consult with average of 3.16 hours compared with those not receiving surgery consult with an average of 2.21 hours (P = 0.00). Patients' average LOS was also significantly longer for those who received x-rays by approximately 49 minutes compared with those who were not imaged (P = 0.00). In reviewing practices from other major medical centers, we hypothesized that we could potentially decrease LOS by targeting consultation rate and imaging rate. Objective: The aim of this study is to determine if implementation of a GT replacement pathway can decrease LOS by standardizing which patients receive surgery consultation and/or imaging studies for placement. Design/Methods: Initially, 1099 patient visits from 2019 to 2022 were gathered for retrospective chart review. IRB approval was obtained from the local institution. When gathering data on measures, patients that were admitted were excluded. Hospital utilization and other measures were reviewed, including surgery consults, x-ray confirmatory imaging, time upon arrival of the ED, etc. A GT replacement pathway was implemented with designated diagnostic codes in June/July 2023. At 6 months post implementation (December 2023/January 2024), the study will query identical measures to previous study in similar patient population. Data analysis will then be completed over the next two months comparing our pre- and post-intervention data to see if there is a statistically significant decrease in LOS following our intervention.
