1. Adherence to and outcomes of a University-Consortium gastroschisis pathway
- Author
-
Daniel A. DeUgarte, Kara L. Calkins, Yigit Guner, Jae Kim, Karen Kling, Katelin Kramer, Hanmin Lee, Leslie Lusk, Payam Saadai, Cherry Uy, Catherine Rottkamp, Jamie Anderson, Aubrey Blanton, Nina Boe, Erin Brown, Michael Choy, Raymond Dougherty, Diana Farmer, Nancy Field, Laura Galganski, Hedriana Herman, Shinjiro Hirose, Gina James, Elyse Love, John McGahan, Amelia McLennan, Giselle Melendres, Francis Poulain, Amy Powne, Gary Raff, Laila Rhee Morris, David Schrimmer, Simran Sekhohn, Sherzana Sunderji, Veronique Tache, Melissa Vanover, Jay Yeh, M Baraa Allaf, Katie Bacca, Elizabeth Blumenthal, Kari Bruce, Lisa Carroll, Robert Day, Jennifer Duffy, David Gibbs, Afshan Hameed, Tamara Hatfield, Alexandra Iacob, Jennifer Jolley, Mustafa Kabeer, Nafiz Kiciman, Nancy Lee, Carol Major, Joshua Makhoul, Yona Nicolau, Elizabeth Patberg, Christina Penfield, Manuel Porto, Pamela Rumney, Valeria Simon, Lizette Spiers, Melissa Westermann, Peter Yu, Kara Calkins, Judith Chung, Ilina Datkhaeva, Daniel DeUgarte, Uday Devaskar, Jaime Deville, Rachel Gutkin, Carla Janzen, Howard Jen, Daniel Kahn, Suhas Kallapur, Steven Lee, Steven Lerman, Melanie Maykin, Aisling Murphy, Tina Nguyen, Victoria Niklas, Rashmi Rao, Gary Satou, Emily Scibetta, Mark Sklansky, Rebecca Stark, Katie Strobel, Renea Sturm, Khalil Tabsh, Afshar Yalda, Rebecca Adami, Laith Alshawabkeh, Tracy Anton, Jerasimos Ballas, Stephen Bickler, Divya Chhabra, Charlotte Conturie, Erika Fernandez, Aileen Fernando, Neil Finer, Andrew Hull, Diana Johnson, Leah Lamale-Smith, Louise Laurent, Frank Mannino, Dora Melber, Mishella Perez, Andrew Picel, Dolores Pretorius, Sandy Ramos, Diana Sanford, Maryam Tarsa, Vy Tran, Douglas Woelkers, Kathy Zhang-Rutledge, Katie Archbold, Victoria Berger, Paul Brakeman, Melissa Catenacci, Shilpa Chetty, Hillary Copp, Emily Edwards, Vickie Feldstein, Neda Ghaffari, Ruth Goldstein, Juan Gonzalez, Kristen Gosnell, Joanne Gras, Michael Harrison, Whitnee Hogan, Romobia Hutchinson, Roxanna Irani, Priyanka Jha, Roberta Keller, Maureen Kohi, Katherine Kosiv, Katie Kramer, Billie Lianoglou, Jennifer Lucero, Tippi MacKenzie, Anne Mardy, Erin Matsuda, Edward Miller, Anita Moon-Grady, Tara Morgan, Amy Murtha, Mary Norton, Natalie Oman, Benjamin Padilla, Shabnam Peyandi, Andrew Phelps, Liina Poder, Annalisa Post, Larry Rand, Naseem Rangwala, Frederico Rocha, Mark Rollins, Melissa Rosenstein, Janice Scudmore, Rachel Shulman, Dorothy Shum, Teresa Sparks, Jeffrey Sperling, Katherine Swanson, Martha Tesfalul, Stephanie Valderramos, Lan Vu, Amanda Yeaton-Massey, Lisa Arcilla, Stacie Bennett, Erin Corbett, and Howard Rosenfeld
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Cohort Studies ,Hospitals, University ,03 medical and health sciences ,0302 clinical medicine ,Clinical pathway ,030225 pediatrics ,medicine ,Humans ,Intubation ,Gastroschisis ,Mechanical ventilation ,Wound Closure Techniques ,business.industry ,Infant, Newborn ,General Medicine ,Evidence-based medicine ,Length of Stay ,medicine.disease ,Respiration, Artificial ,Discontinuation ,Treatment Outcome ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Pediatrics, Perinatology and Child Health ,Cohort ,Emergency medicine ,Surgery ,Guideline Adherence ,business ,Historical Cohort - Abstract
Our multi-institutional university consortium implemented a gastroschisis pathway in 2015 to standardize and improve care by promoting avoidance of routine intubation and paralysis during silo placement, expeditious abdominal wall closure, discontinuation of antibiotics/narcotics within 48 h of closure, and early initiation/advancement of feeds.Adherence to the gastroschisis pathway was prospectively monitored. Outcomes for the contemporary cohort (2015-2018) were compared with a historical cohort (2007-2012).Good adherence to the pathway was observed for 70 cases of inborn uncomplicated gastroschisis. The contemporary cohort had significantly lower median mechanical ventilator days (2 versus 5; p 0.01) and antibiotic days (5.5 versus 9; p 0.01) as well as earlier days to initiation of feeds (12 versus 15; p 0.01). However, no differences were observed in length of stay (28 versus 29 days; p = 0.70). A skin closure technique was performed in 66% of the patients, of which 46% were performed at bedside without intubation, the assistance of an operating-room team, or general anesthesia.In this study, adherence to a clinical pathway for gastroschisis across different facilities was feasible and led to reduction in exposure to mechanical ventilation and antibiotics. The adoption of a bedside skin closure technique appears to facilitate compliance with the pathway.Level II/III TYPE OF STUDY: Prospective comparative study with historical cohort.
- Published
- 2020
- Full Text
- View/download PDF