Standardization Improves Discharge Care Coordination for Children with Nasogastric Tubes
Year: 2025
Type: article
Abstract: Introduction: Discharging patients with new nasogastric tubes (NGTs) for enteral nutrition at home is complex and requires intricate care coordination and education from a multidisciplinary team. We designed a quality improvement (QI) initiative to improve efficiency and decrease variation in care coordination for patients discharged with a new NGT. Our objective was to reduce mean modified hospital length of stay (mLOS) by 10% from baseline within 6 months and sustain improvement for 12 months. Methods: Applying the Model for Improvement, we used plan-do-study-act cycles to improve NGT discharge care coordination using a multidisciplinary team. Primary interventions rooted in Lean methodology included creating a standardized discharge algorithm, utilizing nurse practitioners as care coordination champions, routine consultation of an enteral tube service (ETS), and implementing a formula substitution guide. The primary outcome measure was mean mLOS. The process measure was the time from NGT placement to ETS consult. Balancing measures were ETS consult volume and 30-day healthcare reutilization. Statistical process control charts measured the impact of interventions. Results: Baseline mLOS decreased from 8.2 to 7.4 days with a sustained reduction in process variability over time. Time from NGT placement to ETS consult decreased from 4.1 to 3.0 days. There were no changes in 30-day healthcare reutilization or ETS consult volume over time. Conclusions: A multidisciplinary quality improvement initiative effectively improved complex NGT transitional care planning and was sustained over time.
Source: Pediatric Quality and Safety
Authors: Lisa M. Rickey, Katharine Nagle, Julia Perkins, Caroline Kohler, Benjamin Ethier, Kristen Fontaine, Susan Matherson, Anne M. Stack, Maireade E. McSweeney
Institutions: Boston Children's Hospital, Harvard University
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4411916333