Y. R. Yu1,2, P. I. Abbas1,2, K. M. Murphy1,2, L. J. Stephens1,2, V. A. Victorian1,2, T. C. Lee1,2 1Baylor College Of Medicine,Michael E. DeBakey Department Of Surgery,Houston, TX, USA 2Texas Children’s Hospital,Division Of Pediatric Surgery,Houston, TX, USA
Introduction: Our institution created a standardized educational pamphlet and implemented a formal gastrostomy education course for our gastrostomy tube (GT) patients. This study evaluates the impact of this program on post-surgical resource utilization.
Methods: We included children under 18 years old who received a surgical GT from 10/2013-7/2015. Patients were stratified into pre-intervention (pre) (10/2013–9/2014) or post-intervention (post) (10/2014–7/2015) groups. The post cohort was further subdivided into formal education (FE) or nursing discharge education using an educational pamphlet(PE). Unnecessary emergency department (UE) visits were defined as complications amenable to management in clinic or home, such as granulation tissue, dislodgment >6 weeks, or leakage. Clinic visits outside of routine follow-up within 1 year of surgery and telephone calls related to GT care within 30 days and 1 year after surgery were analyzed. Anonymous 5-point Likert scale (5-high understanding to 1-low understanding) surveys were administered to evaluate the formal GT education course. We performed statistical analysis using χ2 test or Fisher’s exact test and Mann-Whitney U where appropriate.
Results:Four hundred nineteen patients were included (245 pre and 174 post); median age 12.2 months (IQR 4.9-59.6) and average follow-up of 219±173 days. Seventy-two (41%) patients attended the gastrostomy education course and 102 (59%) received an educational pamphlet. Overall, there was a significant decrease in rate of UE visits (pre-25% vs. post-13%, p=0.003). This led to a 61.8% reduction in cumulative direct variable costs associated with UE visits (pre-$19,021 vs. post-$7,261). GT related phone call rate within 30 days (pre-9.8% vs post-10.9%, p=0.71) and within a year (pre-26.1% vs. post-19%, p=0.09) of surgery was similar. However, there was a significant decrease in non-routine clinic visits (pre-32.7% vs. post-12.6%, p<0.001) following gastrostomy tube education. Type of education (FE vs. PE) did not affect UE visits, call rate or non-routine clinic visits. Seventy-seven patients completed a course survey; 13 (17%) had FE. FE significantly improved understanding of granulation tissue, troubleshooting a clogged port, and minimized uncertainty with GT care [Table].
Conclusion:A standardized GT education protocol decreases emergency room and non-routine clinic visits. Unnecessary emergency department visits for GT issues that can be safely managed at home, with the appropriate education, has a large impact on healthcare costs. While, there was no difference in post-surgical resource utilization based on educational modality, parents have a better understanding of gastrostomy tube care in a formal class setting.
