Nurse Practitioner-Managed Clinic Reduces Emergency Department Visits for Parents of Children With Problematic Gastrostomy Tubes

Abstract

Background Gastrostomy tube (G-tube) placement is commonly performed on pediatric patients but has high rates of emergency department (ED) utilization. We hypothesized that a nurse-practitioner-driven G-tube clinic would reduce ED visits and complications and improve provider and patient satisfaction. Methods After institutional review board approval, a retrospective chart review was conducted for all patients < 18 years old undergoing G-tube placement between January 2014 and June 2018. Data collected included demographics, indication, and type of G-tube as well as ED visits, clinic visits, and outcomes up to 1-year postoperative. Surveys were distributed to providers and parents to assess attitudes toward the clinic. Results There was a decrease in the number of physician clinic visits, but there was no difference in overall 30- or 90-day ED visits after institution of the G-Tube Clinic. In the cohort of patients who had problematic G-tube-related problems, such as granulation, plugged tube, or tube dislodgement, creation of the G-Tube Clinic significantly reduced 30-day (0.37 vs. 0.07, p = .0008), 90-day (0.27 vs. 0.73, p = .0031), and 1-year (0.6 vs. 1.18, p = .014) ED visits. Surgeon and patient satisfaction were improved with clinic implementation. Conclusions Implementation of a nurse-practitioner-managed clinic resulted in reduction in 30-day, 90-day, and 1-year ED visits among patients with gastrostomy issues and is associated with high levels of patient and provider satisfaction.

An Interdisciplinary Intervention to Reduce Gastrostomy-tube-related Pediatric Emergency Department Visits

“…Traditionally, it is thought the problem of ED overcrowding is the fault of the ED itselfstaff shortage, lack of space, incompetence in patient throughput, and so forth-but in reality, the problem of ED overcrowding is much larger than one department and is, indeed, a health care issue where all aspects of the medical institution are involved (Jeanmonod, 2018). Prior research has shown that including interdisciplinary care, including nurse-practitioner-led clinics, can reduce ED utilization (Maselli et al, 2021).…”