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Prospective implementation of algorithmic patient selection for gastrostomy tube placement consultations: a pre- and post-intervention analysis.

Cano JJ, Thrift AP, El-Serag HB. Prospective implementation of algorithmic patient selection for gastrostomy tube placement consultations: a pre- and post-intervention analysis. Clinical and experimental gastroenterology. 2019 May 30; 12:231-237.

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Abstract:

Studies have shown high but variable mortality following gastrostomy tube (GT) placement. There are no standard practice guidelines for GT placement. To evaluate if implementation of patient selection and prognosis algorithms for GT insertion has favorable effects on patient outcomes. This was a pre-, post-cohort analysis in a Veterans Affairs hospital. We implemented a patient selection algorithm aided by the Sheffield Gastrostomy Scoring System (SGSS) in July 2015. We reviewed all referrals to the inpatient service for a GT between July 2014 and June 2016 (pre-, post- implementation), and collected albumin and SGSS at time of consultation, date of GT insertion, and outcomes including vital status and albumin 30 days post-consultation. Patients were followed until 30 October 2016. We compared outcomes pre- and post-implementation. A total of 126 referrals were reviewed, 68 pre- and 58 post-algorithm implementation. Seventy-seven GTs were placed; 58 (75.3%) fulfilled the algorithm-appropriate indications. The mean SGSS was significantly lower among patients in whom GT was placed for algorithm-appropriate indications 2.03 (SD = 0.86) vs inappropriate indications (2.59, SD = 0.63; < 0.001). Sixty-five (51.6%) patients died by conclusion of study. Thirty day mortality after GT placement was 26.2% (post- (22.4%) vs pre- (29.4%)). Changes in serum albumin at day 30 was non-significant. The use of algorithm guidance by the prospective use of the SGSS was associated with a higher likelihood of GT placement both overall and for algorithm-appropriate indications.




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