Berman Loren, Hronek Carla, Raval Mehul V, Browne Marybeth L, Snyder Charles L, Heiss Kurt F, Rangel Shawn J, Goldin Adam B, Rothstein David H
Nemours-A.I. duPont Hospital for Children, Wilmington, Dle.; Sidney Kimmel College of Medicine, Philadelphia, Pa.; Children's Hospital Association, Overland Park, Kans.; Emory University, Children's Healthcare of Atlanta, Atlanta, Ga.; Lehigh Valley Children's Hospital, Morsani College of Medicine, University of South Florida, Allentown, Pa.; Children's Mercy Hospital, Kansas City, Mo.; Boston Children's Hospital, Harvard Medical School, Boston, Mass.; Department of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Wash.; University of Washington School of Medicine, Seattle, Wash.; Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, N.Y.; and Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, N.Y.
Pediatr Qual Saf. 2017 Feb 23;2(2):e016. doi: 10.1097/pq9.0000000000000016. eCollection 2017 Mar-Apr.
Gastrostomy tube (GT) placement is one of the most common operations performed in children, and it is plagued by high complication rates. Previous studies have shown variation in readmission and emergency room visit rates across different children's hospitals, with both low and high outliers. There is an opportunity to learn how to optimize outcomes by identifying practices at high-performing institutions.
Surgeons and nurses routinely involved in GT care at 8 high-performing pediatric centers were identified. We conducted structured interviews focusing on the approach to GT education, technical aspects of GT placement, and postoperative management. Summary statistics were performed on quantitative data, and the open-ended responses were analyzed by 2 independent reviewers using content analysis.
Several common practices among high-performing centers were identified (standardized approach to education, availability by phone and in clinic to manage GT-related issues, and empowering families to feel confident with troubleshooting and dealing with GT problems). There was substantial variation in operative technique and postoperative care. The participants expressed that technical aspects of operative placement and postoperative management of feedings and common complications are not as important as education, availability, and empowerment in optimizing outcomes.
We have identified common themes among pediatric centers with favorable outcomes after GT placement. Identifying which components of GT care are associated with optimal outcomes is critical to our understanding of current practice and may help identify opportunities to improve care quality.
胃造口管（GT）置入术是儿童中最常见的手术之一，且并发症发生率很高。先前的研究表明，不同儿童医院的再入院率和急诊室就诊率存在差异，既有低的异常值，也有高的异常值。通过识别高绩效机构的做法，有机会学习如何优化治疗结果。
确定了8个高绩效儿科中心中经常参与GT护理的外科医生和护士。我们进行了结构化访谈，重点关注GT教育方法、GT置入的技术方面以及术后管理。对定量数据进行了汇总统计，并由2名独立评审员使用内容分析法对开放式回答进行了分析。
确定了高绩效中心的几种常见做法（标准化教育方法、通过电话和门诊提供服务以处理与GT相关的问题，以及让家庭有信心解决和处理GT问题）。手术技术和术后护理存在很大差异。参与者表示，在优化治疗结果方面，手术置入的技术方面、术后喂养管理和常见并发症不如教育、可及性和赋权重要。
我们已经确定了GT置入术后有良好治疗结果的儿科中心的共同主题。确定GT护理的哪些组成部分与最佳治疗结果相关，对于我们理解当前实践至关重要，可能有助于识别改善护理质量的机会。
