Children’s Hospital Reduces G-Tube Dislodgement with ACS QI Principles

The ACS Quality Improvement Case Study Repository is a centralized platform of quality improvement projects implemented by participants of the ACS Quality Programs.

One such project, Reducing gastrostomy dislodgements and ED visits after gastrostomy (G)-tube insertion; Improving health equity for children with G-tubes, within the Children’s Surgery Verification Program Improvement Program, highlights how the principles of ACS Quality Programs can lead to reductions in a complication for pediatric patients in need of enteral feeding tubes.

Recognizing that dislodgement was the most common reason for G-tube related emergency department visits, stakeholders at Golisano Children’s Hospital at the University of Rochester, New York, aimed to reduce pediatric dislodgement within 3 months of insertion by 25% within 1 year of implementing the initiative.

After forming a multidisciplinary QI team of surgeons, pediatric emergency medicine, ACS NSQIP Surgical Clinical Reviewers, and more, the group standardized care in the pre-, intra-, and postoperative phases with checklists, processes, and engagement.

The team observed a 65% reduction in dislodgments per month compared to pre-intervention, especially in the in-patient setting. Additionally, disparities in rates of dislodgment (where children from deprived neighborhoods suffered more dislodgment) were mitigated. The team also noticed an unintended benefit alongside this intervention, as the length of stay was reduced.

Although the stakeholders encountered issues with keeping the growing QI team unified in accountability, the G-tube QI project was well received by care teams and hospital administrators due to visible success and high value. The standardization provided by backing ACS Quality Programs can play an important role in helping interventions find success.