Impact of a standardized post-surgical gastrostomy tube education program on emergency room resource utilization

Impact of a standardized post-surgical gastrostomy tube education program on emergency room resource utilization 

Paulette Abbas^1,2, Kathleen Murphy^1,2, Lindsay Stephens^1,2 Veronica Victorian^1,2, Timothy Lee^1,2

¹The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Pediatric Surgery, Texas Children’s Hospital, Houston, Texas

 

Purpose:  For improved gastrostomy tube (GT) education, our institution created a standardized educational pamphlet and implemented a formal gastrostomy education course. This study sought to evaluate the impact of this program on emergency room visits and overall cost savings.

 Methods:The study included all children who received a surgical GT from 10/2013 to 7/2015. Patients were stratified into pre-intervention (10/2013 – 9/2014) or post-intervention (10/2014 – 7/2015). The post cohort was further subdivided into formal education (FE) or standard nursing discharge education through the pamphlet (PE). Unnecessary ED (UE) visits were defined as complications amendable to elective management in clinic or home, such as granulation tissue, dislodgment >6 weeks, or leakage. Anonymous 5-point Likert scale (5-high understanding to 1-low understanding) surveys were administered to assess impact of FE.

 Results: 430 patients were in the study. The median age was 13.8 months (IQR 5.0-68.8). Average follow-up for the entire cohort was 222±173 days. When comparing pre to post-patients, the rate of UE visits (23% vs. 11%, p=0.002) and total number of UE visits (median 1 visit (IQR 1-1) vs. 1  visit (IQR 0-1), p=0.032) decreased, reducing the cumulative direct variable cost associated with the visits ($14616 vs. $4644). Seventy-seven patients completed the survey; 13 (17%) had FE. FE significantly improved understanding of granulation tissue, troubleshooting a clogged port, and minimized uncertainty with GT care

 Conclusions: The implementation of a standardized education protocol improved family understanding of GT care and decreased unnecessary ED visits. Parents appear to have a better understanding of GT care in a formal class setting.