Staying Put: A Single Institution Quality Improvement Initiative to Reduce Early Gastrostomy Tube Dislodgement in Children

PURPOSE: Gastrostomy tube (GT) placement is one of the most common surgical procedures performed in children. Early GT dislodgement is a potentially preventable complication associated with high morbidity, increased healthcare utilization, and need for early instrumentation or re-operation. This quality improvement initiative aimed to reduce the rate of early GT dislodgement from 14.3% to 7% within 12 months.

METHODS: After identifying a high rate of early GT dislodgements, a team of multidisciplinary stakeholders developed a quality improvement initiative to reduce early dislodgements, defined as any dislodgement within 60 days of surgery. The intervention included: 1) standardization of post-operative GT dressing; 2) robust family education focusing on common GT problems, GT dressings and securement, and instructions for management if dislodgement occurs; 3) nursing education and hands-on demonstration; and 4) creation of a post-operative order set, including the new dressing order and instructions to disconnect the extension tubing when not in use. Process measures included adherence to post-operative dressings and completion of family education. The outcome measure was GT dislodgement rate.

RESULTS: Since Go-Live, there has been 100% compliance with completion of family education. Compliance with standard post-operative dressing initially lagged, but has been 100% since February 2025, with the exception of October 2025. At 1.5 years post-implementation, the rate of early dislodgements was not trending in the desired direction, so we identified patients at higher risk for dislodgement based on demographic factors. All high-risk patients are contacted via telephone two weeks post-operatively to check in and reinforce family education. The rate of early dislodgement has decreased from 14.8% to 4.3%.

CONCLUSION: Interventions including hospital-wide post-operative protocols, standardized dressings, high-quality parent education, and targeted efforts for high-risk patients can reduce rates of early GT dislodgement in children and related morbidity.