Emergency Department Visits and Readmissions among Children after Gastrostomy Tube Placement

Goldin, Adam B.; Heiss, Kurt F.; Hall, Matt; Rothstein, David H.; Minneci, Peter C.; Blakely, Martin L.; Browne, Marybeth; Raval, Mehul V.; Shah, Samir S.; Rangel, Shawn J.; Snyder, Charles L.; Vinocur, Charles D.; Berman, Loren; Cooper, Jennifer N.; Arca, Marjorie J.

doi:10.1016/j.jpeds.2016.03.032

Cited by 65 publications

(47 citation statements)

References 19 publications

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“…Our outpatient safety outcomes were reassuring in the low need for admission for tube‐related complications, and our patient's ED utilization, especially by those with GTs, was comparable with that of Khalil et al in their study of NICU discharges and with other studies of outpatient GT complications . Our study did show a small reduction in GT placement prior to discharge, but when accounting for outpatient conversion to GT, both preintervention and postintervention cohorts had ≈17% of infants with GTs at 6 months postdischarge.…”

Section: Discussionsupporting

confidence: 83%

Creation of a Standard Model for Tube Feeding at Neonatal Intensive Care Unit Discharge

White

Ermarth

Thomas

et al. 2019

J Parenter Enteral Nutr

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Background Feeding dysfunction is a common consequence of prematurity and illness in neonates, often requiring supplemental nasogastric (NG) or gastrostomy (GT) feeding tubes. A standardized approach to the discharge of infants receiving home enteral nutrition (HEN) is currently lacking. Methods The Home Enteral Feeding Transitions (HEFT) program was developed to identify patients eligible for HEN and create a standard discharge process. A structured tool helped determine discharge timing and route, and a dedicated outpatient clinic was created for infants discharged on HEN. Demographic, inpatient, and outpatient data were prospectively collected and compared with a historical cohort. Results A total of 232 infants discharged from our neonatal intensive care unit (NICU) over 9 months met inclusion criteria. Ninety‐eight (42%) were discharged with HEN, 68 NG and 30 GT, compared with 134 (58%) receiving full oral feeds. This represented a 10% increase in HEN utilization (P = 0.003) compared with our historical control group. Median HEN length of stay was 31.5 days compared with our historical average of 41 days (P = 0.23). Frequency of emergency department visits and admissions because of HEN was unchanged postintervention. Parents were satisfied (8.6/10), and 98% said they would choose HEN again. The median time to NG discontinuation after discharge was 13.5 days, with an estimated cost savings of $2163 per NICU day. Conclusion Our program is the first of which we know to use a standard care‐process model to guide the decision‐making and utilization of HEN at NICU discharge. HEFT shows that HEN at NICU discharge can be safe and effective, with high parental satisfaction.

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Section: Discussionsupporting

confidence: 83%

Creation of a Standard Model for Tube Feeding at Neonatal Intensive Care Unit Discharge

White

Ermarth

Thomas

et al. 2019

J Parenter Enteral Nutr

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“…Other studies found race and insurance status to predict return to the ED or readmission, but this was not true of our population [5,13–15]. Ureteroscopy was associated with a high number of potentially preventable visits for both pediatric and adult patients.…”

Section: Discussionmentioning

confidence: 57%

Comparison of 30-day emergency department bouncebacks after pediatric versus adult urologic surgery

Shepard

Wan

2017

Journal of Pediatric Urology

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Summary Introduction More pediatric patients seem to present to the emergency department (ED) for non-urgent matters after urologic procedures than adult patients. Under new and expanding healthcare reform, pediatric urologists may be penalized for these visits. We compare our 30-day postoperative bounceback rates to the ED and the acuity of the concerns in these populations. Materials and methods All urology consults at our institution are maintained on a prospectively tracked database. We identified all patients who presented to our adult or pediatric ED between July 2013 and June 2015 within 30 days of a urologic procedure. We investigated the patient demographics including age, race, insurance, distance from the home zip code to the ED, procedures performed, chief complaint in the ED, diagnosis, and treatment required. Results In our pediatric group, there were 67 visits for 56 patients (19 female, 37 male, mean age 6.8 years), which represents an overall bounceback incidence of 2.7%. Of those, 19% required admission (0.60% overall readmission rate), 10% underwent a procedure (0.32% reoperative rate, 18% required catheter manipulation/placement, 13% were given a prescription (most commonly for constipation), 6% required local wound care, and 33% were reassured only. Most pediatric patients had private insurance (62.5%) and those with private insurance or who were uninsured tended to require only reassurance compared to those with Medicare/Medicaid (p = 0.053). In the adult population, there were 369 visits in 310 patients (111 female, 199 male, mean age 55.4 years) for an incidence of 4.4%. Of those, 42% were admitted (2.2% overall readmission rate), 14% underwent a procedure (0.74% reoperative rate), 11% required catheter manipulation/placement, 14% were given medication (most commonly antibiotics and narcotics), 4% were given local wound care, and 12% were reassured. Most adult patients had Medicare/Medicaid (48.7%), but insurance type was not related to treatment required (p = 0.382). On multivariable analysis, pediatric patients, closer proximity to the hospital, and earlier postoperative day at presentation to the ED were predictive of requiring only reassurance. Conclusions Compared to adults, pediatric patients are less likely to return to the ED postoperatively (p < 0.001), but they are significantly more likely to require only reassurance (p < 0.001) while adults are significantly more likely to require hospital admission (p < 0.001). In both groups, nearly one-third of patients required only catheter care or medication. This difference could have significant implications for new healthcare policy.

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“…Improved education, discharge protocols, and scheduled maintenance are possible interventions to minimize or prevent maintenance related complications. 20–22 However, while comprehensive multidisciplinary discharge protocols have demonstrated reduced emergency department visits for minor gastrostomy tube complications, they have not been able to reduce the rate of complications. 21 …”

Section: Discussionmentioning

confidence: 99%

Surgical Feeding Tubes in Pediatric and Adolescent Cancer Patients: A Single-institution Retrospective Review

Hamilton

Curtin

Slack

et al. 2017

Journal of Pediatric Hematology/Oncology

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The purpose of our study was to evaluate surgical enteric access in pediatric cancer patients to determine factors associated with postoperative complications. We performed a single institution retrospective review of all patients<21 years old with a primary cancer diagnosis who underwent surgical procedures for enteral access between 2004–2014. Multivariate logistic regression was performed to determine independent predictors of postoperative complications. During the study period, 122 patients had surgically placed feeding tubes, of whom 58% developed one or more complication(s) and 16% experienced a major complication. No single factor was significantly associated with developing any complication or major complication. Several trends were noted including increased complications associated with jejunostomy tubes, percutaneous endoscopic gastrostomy tubes, and abdominal radiation. Surgically placed enteric access in pediatric and adolescent cancer patients is associated with an extremely high complication rate emphasizing the importance of careful evaluation of these patients prior to embarking on surgical feeding access. Future work should evaluate mechanisms to decrease complications and/or explore alternative methods to provide supplemental nutrition in children and adolescents with cancer.

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Emergency Department Visits and Readmissions among Children after Gastrostomy Tube Placement

Cited by 65 publications

References 19 publications

Creation of a Standard Model for Tube Feeding at Neonatal Intensive Care Unit Discharge

Creation of a Standard Model for Tube Feeding at Neonatal Intensive Care Unit Discharge

Comparison of 30-day emergency department bouncebacks after pediatric versus adult urologic surgery

Surgical Feeding Tubes in Pediatric and Adolescent Cancer Patients: A Single-institution Retrospective Review

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