| الوصف: |
Thesis (Master's)--University of Washington, 2015 ; Implementation of a hospital-wide standardized feeding tube pathway is associated with a reduction in health care utilization Richards MK, McAteer JP, Li C, Shaw DW, Wahbeh GT, Foti JL, Melzer L, BA, Goldin AB Background Relatively recent medical advances such as percutaneous endoscopic, image-guided, laparoscopic and even robotic gastrostomy tube (GT) placement have become common among pediatric patients. These minimally invasive approaches may be quick to perform and simple to complete, but they are not without subsequent complications such as infection, leakage, device malfunction, dislodgement, hemorrhage and intra-abdominal organ injury. In addition, many of the procedures require planned interventions such as tube exchanges or conversions from gastrostomy to gastrojejunostomy. We hypothesized that implementation of a hospital-wide clinical standardized work (CSW) feeding tube pathway would be associated with a reduction in hospital resource utilization. Methods We performed a retrospective cohort study comparing all children undergoing GT or gastrojejunostomy tube (GJ) placement following implementation of the hospital-wide clinical standardized work pathway (CSW) from June 1, 2013 - July 31, 2014 to those placed in a previous time period (January 1, 2010 - December 31, 2011). We limited follow up time to 365 days in both groups. Our primary outcome was the change in the rate of hospital resource utilization, defined as 1) GT/GJ-related emergency department visits, 2) planned events, or 3) unplanned events before and after implementation using adjusted Poisson regression. We also compared the time to first event between cohorts using adjusted Cox regression to understand the relative number of children requiring repeat utilization (p<0.05). Adjustment factors included age, ASA class, gender, insurance, race, comorbidities and GT/GJ at initial placement. Results Prior to CSW implementation, 145 (48.7%) devices were placed surgically, 113 (37.9%) ... |