QI initiative may cut use of feeding tubes in young children

Last Updated: 2020-01-29

By Reuters Staff

NEW YORK (Reuters Health) - Through a quality-improvement initiative and development of an evidence-based guideline, clinicians at Boston Children's Hospital have safely reduced rates of gastrostomy-tube placement in infants and young children by almost half.

This reduction far surpassed their 10% goal and has been sustained in the subsequent three years of monitoring, Dr. Maireade McSweeney and colleagues report in Pediatrics.

They note that rates of gastrostomy-tube placement are rising nationally, especially among infants. Although intended to improve quality of life, G-tube placement may have unforeseen consequences, including complications after placement, leading to added costs. The decision and timing of tube placement often varies from provider to provider.

To standardize and reduce rates of G-tube placement at their center, between 2014 and 2018, the researchers designed and implemented a quality improvement intervention creating an evidence-based guideline for gastroenterologists to use when evaluating patients aged two years and younger with respiratory symptoms who were found to aspirate on videofluoroscopic swallow study (VFSS).

"The key tenets of the guideline were obtaining a VFSS in any patient with suspected aspiration and having a trial of thickened or nasogastric tube feedings, when possible, before moving forward with gastrostomy tube placement," Dr. McSweeney and colleagues note in their article. The guideline is a two-page flowchart incorporating different feeding pathways.

Among 6,125 children who completed a VFSS during the study period, 27.2% were found to have aspiration or penetration. During the course of the project, average gastrostomy-tube placement fell from 10.9% at the start of guideline implementation to 5.2% almost a year after initiation, an achievement that has been maintained.

Importantly, the "balancing measures" of ED visits and hospital readmissions did not change during the study period, Dr. McSweeney and colleagues report.

"We feel that we were able to achieve our target through offering continued education and support for our colleagues on guideline use and promoting oral feedings in patients when possible," they note.

"With the increasing trend both locally and nationally to place gastrostomy tubes in younger infants, we feel this guideline may provide a scaffold to reduce gastrostomies nationally," they conclude.

The study had no commercial funding and the authors have no relevant disclosures.

SOURCE: https://bit.ly/2RXWvey Pediatrics, online January 29, 2020.