Richards Morgan K, Li Christopher I, Foti Jeffrey L, Leu Michael G, Wahbeh Ghassan T, Shaw Dennis, Libby Arlene K, Melzer Lilah, Goldin Adam B
Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington, 98105, United States; Department of Surgery, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, Washington, 98195, United States.
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, Washington, 98109, United States.
J Pediatr Surg. 2016 Oct;51(10):1674-9. doi: 10.1016/j.jpedsurg.2016.05.012. Epub 2016 Jun 2.
BACKGROUND/PURPOSE: Children requiring gastrostomy/gastrojejunostomy tubes (GT/GJ) are heterogeneous and medically complex patients with high resource utilization. We created and implemented a hospital-wide standardized pathway for feeding device placement. This study compares hospital resource utilization before and after pathway implementation.
We performed a retrospective cohort study comparing outcomes through one year of follow-up for consecutive groups of children undergoing GT/GJ placement prepathway (n=298, 1/1/2010-12/31/2011) and postpathway (n=140, 6/1/2013-7/31/2014) implementation. We determined the change in the rate of hospital resource utilization events and time to first event.
Prior to implementation, 145 (48.7%) devices were placed surgically, 113 (37.9%) endoscopically and 40 (13.4%) using image guidance. After implementation, 102 (72.9%) were placed surgically, 23 (16.4%) endoscopically and 15 (10.7%) using image guidance. Prior to implementation, 174/298 (58.4%) patients required additional hospital resource utilization compared to 60/143 (42.0%) corresponding to a multivariate adjusted 38% reduced risk of a subsequent feeding tube related event.
Care of tube-feeding dependent patients is spread among multiple specialists leading to variability in the preoperative workup, intraoperative technique and postoperative care. Our study shows an association between implementation of a standardized pathway and a decrease in hospital resource utilization.
背景/目的：需要胃造口术/胃空肠造口术管（GT/GJ）的儿童是异质性的，且医疗情况复杂，资源利用率高。我们创建并实施了一项全院范围内的喂养装置放置标准化流程。本研究比较了该流程实施前后医院的资源利用率。
我们进行了一项回顾性队列研究，比较了连续两组接受GT/GJ放置的儿童在流程实施前（n = 298，2010年1月1日 - 2011年12月31日）和实施后（n = 140，2013年6月1日 - 2014年7月31日）一年随访期内的结果。我们确定了医院资源利用事件发生率的变化以及首次事件发生的时间。
在实施之前，145例（48.7%）装置通过手术放置，113例（37.9%）通过内镜放置，40例（13.4%）使用图像引导放置。实施后，102例（72.9%）通过手术放置，23例（16.4%）通过内镜放置，15例（10.7%）使用图像引导放置。实施之前，174/298例（58.4%）患者需要额外的医院资源利用，而相应的实施后为60/143例（42.0%），这相当于多变量调整后后续喂养管相关事件风险降低了38%。
依赖管饲的患者的护理分散在多个专科医生之间，导致术前检查、术中技术和术后护理存在差异。我们的研究表明，标准化流程的实施与医院资源利用率的降低之间存在关联。
