561 - GJ Express: A multidisciplinary quality improvement approach for decreasing utilization of sedation and anesthesia for gastrojejunostomy (GJ) exchanges
Saturday, April 23, 2022
3:30 PM – 6:00 PM US MT
Poster Number: 561 Publication Number: 561.244
Sarah Haen, Golisano Children's Hospital at The University of Rochester Medical Center, Pittsford, NY, United States; Samantha Ferguson, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Fear Kathleen, University of Rochester Medical Center, Rochester, NY, United States; Alexander Clark, University of Rochester Medical Center, Rochester, NY, United States; Christine T. Boerman, University of Rochester Medical Center, Rochester, NY, United States; Carly Hochreiter, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Jan Schriefer, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Megan Gabel, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; David Lee, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Kate G. Ackerman, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
Professor of Pediatrics/Sr Vice Chair Innovation & Integration University of Rochester - Golisano Children's Hospital Mendon, New York, United States
Background: Although many children’s hospitals rarely use sedation or anesthesia for routine GJ exchanges (published use is < 5%), hospitals caring for children in adult interventional radiology programs often are not at this standard of care. We identified that the reliance on anesthesia/sedation was contributing to delays in providing timely GJ exchanges, resulting in unnecessary hospitalizations.
Objective: We formed a multidisciplinary and highly collaborative group with the goal of providing rapid and high-quality access to GJ exchanges, coined the “GJ Express” program.
Design/Methods: Data were extracted from hospital records using multiple mechanisms for all pediatric interventional radiology procedures (2018 – 2021). Ultimately, Epic OpTime provided the most comprehensive data used to determine patient population and frequency of GJ exchanges. Further analysis including procedure confirmation, use of sedation/anesthesia, and insurance provider was done using data from a review of medical records (n=322 events). Barriers towards weaning from sedation/anesthesia were identified, and patients were identified to wean from anesthesia or sedation to “express”. A weaning program was introduced, and care was redesigned using a multi-specialty approach.
Results: The number of GJ exchanges requiring sedation or anesthesia dropped significantly after introduction of a weaning program (late 2019) with more rapid progress recently after implementing some additional strategies (2021). In 2018 and 2019, 78% required sedation/anesthesia (of n=139). This rate gradually declined, and as of Jan 1, 2022 only 11% of GJ exchange patients require sedation or anesthesia. Financial analysis of professional billing, revenue, and costs revealed that although there is a loss of fee for service anesthesia/sedation billing, there is a total cost savings since the majority of patients have Medicaid related plans. Multiple hospital admissions and emergency room visits were prevented, and families experienced huge time savings with high satisfaction. Conclusion(s): Our team developed a program to identify, evaluate and implement a new workflow for GJ exchanges, improving the quality of care.