Faculty Collaboration Database

Pediatric Gastrojejunostomy Tube Replacement: Effects of Communication on the Need for After-Hours Procedures. J Pediatr Gastroenterol Nutr 2016 Sep;63(3):e27-30

Date

08/23/2016

Pubmed ID

27548250

DOI

10.1097/MPG.0000000000001267

Scopus ID

2-s2.0-84983467690 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

OBJECTIVES: The aim of the study was to determine whether embedding into the radiology report a patient-specific plan in the event of gastrojejunostomy (GJ) tube dysfunction reduces the need for after-hours utilization of pediatric interventional radiology resources for the replacement of GJ tubes.

MATERIALS AND METHODS: This is a Health Insurance Portability and Accountability Act compliant, institutional review board-approved retrospective repeated cross-sectional study of patients requiring after-hours (5 PM-7 AM) or weekend (Saturday and Sunday) GJ tube replacement at a dedicated children's hospital, before and after the inclusion of a patient-specific plan in the radiology report as part of the electronic medical record.

RESULTS: During a 6-month period before the inclusion of a patient-specific plan, there were 242 total GJ tube changes performed by the pediatric interventional radiology service under image guidance. Twenty-six (10.7%) of these procedures were performed outside of standard operating hours at the request of the emergency department (ED) (6/26), inpatient service (8/26), or patient/caregiver (12/26). Of the 8 inpatients, 3 were admitted from the ED for the sole purpose of tube replacement. Data were again collected for 6 months following inclusion of a patient-specific plan during the same seasonal period of the following year. During this period, 240 total image-guided changes were performed. Fifteen (6.2%) were performed outside of standard operating hours at the request of the ED (2/15), inpatient service (4/15), or patient/caregiver (9/15). No patients were admitted for GJ tube replacement procedures following implementation of the enhanced reporting policy. These data indicate a trend toward reduced after-hours resource utilization for GJ tube replacement requests by the ED (23.1%-13.3%), inpatient service (30.8%-26.7%), and all patients (14.7%-11%). Fewer after-hours GJ tube changes reduced cost by proportionately reducing hourly compensation for interventional radiology nurses and technicians.

CONCLUSIONS: Our single-center data suggest that the inclusion of patient-specific recommendations at the end of each radiology GJ tube procedure note, generated in collaboration with the feeding service or primary medical provider, reduces off-hour resource utilization in patients who could otherwise have their tubes replaced during standard operating hours with image guidance. Avoidance of tube-related admissions is likely the greatest source of cost savings, followed by lower radiology technical support costs. Cost savings related to improved ED workflow and reduced patient/family anxiety are difficult to quantify, but likely significant. Future studies should be designed to quantify these savings and to assess the effect of this intervention on patient/caregiver satisfaction.

Author List

Sharafinski ME Jr, Sehnert E, Moe D, Zhang L, Simpson P, Vo NJ

Authors

David C. Moe MD Associate Professor in the Radiology department at Medical College of Wisconsin
Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

After-Hours Care
Child, Preschool
Communication
Continuity of Patient Care
Cross-Sectional Studies
Electronic Health Records
Emergency Service, Hospital
Enteral Nutrition
Female
Gastric Bypass
Hospitals, Pediatric
Humans
Male
Quality Assurance, Health Care
Radiology Department, Hospital
Retrospective Studies
Statistics, Nonparametric