Intervention Data
With standardization of care, the data showed a significant decline in G-tube dislodgements occurring in the hospital within 90 days of insertion (see Figure above). G-tube dislodgements that happened outside of the hospital also decreased in frequency, but to a lesser extent. Interestingly, during the same time (late 2018–2019), the length of stay for G-tube insertion became shorter.
G-Tube Buddy Program
Starting in 2021, the team sought to dig deeper into discovering factors outside of the hospital that were leading to accidental G-tube dislodgement. In an earlier case study, it is noted that “the majority of ED utilization stemmed from a small group of patients with a high proportion of children of non-white race and less socioeconomic advantage determinants of health.”3
Armed with this knowledge, the team made a goal to improve health equity for their G-tube patients, not realizing they actually had already accomplished this goal by standardizing the three phases of care. It was found that G-tube patients living in less-advantaged neighborhoods, based on area deprivation of their neighborhood, had more ED visits after G-tube placement. However, these disparities were largely mitigated after the improvement work was started, as well as standardizing care.4
In April 2022, the G-Tube Buddy Program was piloted. This program aimed to provide psychosocial support for families of children with G-tubes. The program paired an experienced G-tube caregiver with a first-time G-tube caregiver.
The team learned that a high number of G-tube dislodgements happen when the extension tubing is connected during a feed. Given this information, the team at the hospital, as well as the mentors in the Buddy Program, encourage caregivers to be very careful when moving a child during a feeding and be diligent in disconnecting tubing when not in use.
Initially, the G-Tube Buddy Program was offered to families that were seen as high risk for worse outcomes. As of 2023, the program was offered to all children receiving a G-tube at Golisano Children’s Hospital. The program provides quarterly meetings with mentors and regular focus groups.
Dr. Wakeman noted that the mentors and mentees of the program consistently provide feedback that the program is helpful.5 Engaging with families has been noted to be key in understanding issues that are faced outside of the hospital.
G-Tube Pilot Project
An additional benefit of the QI project was making a shift toward sending more neonates home with nasogastric tubes (NG). The team noticed that often, neonates sent home with an NG will mature and never require a G-tube. Given this change in practice, most patients undergoing G-tube placement now come from home rather than already being admitted to the hospital beforehand. This approach provides more time to planning and allows caregivers to better prepare.
Dr. Wakeman noted when this QI project was underway, National Surgical Quality Improvement Program (NSQIP) Pediatric did not capture data on G-tube dislodgements. The G-Tube Pilot Project for NSQIP Pediatric ran January 2023–December 2024 and provided meaningful tracking of G-tube-related events within NSQIP Pediatric, such as accidental dislodgement, ED visits, preoperative upper GI series, and readmissions.
After the conclusion of the G-Tube Pilot, the variables became a procedure targeted set in NSQIP Pediatric, available to all participating sites.
The case study for this quality improvement project, “Reducing Gastrostomy Dislodgements and ED Visits after Gastrostomy (G)-Tube Insertion: Improving Health Equity for Children with G-Tubes,” is featured in the ACS Quality Improvement Case Study Repository.
For more information regarding NSQIP Pediatric and Children’s Surgery Verification Improvement Program, visit facs.org/quality-programs/accreditation-and-verification/childrens-surgery-verification.
