S1497 Optimizing Percutaneous Endoscopic Gastrostomy Tube Placement Wait Times in a Safety Net Hospital (2022)

Introduction: Percutaneous endoscopic gastrostomy (PEG) tube placement is an endoscopic procedure offered for patients with insufficient oral intake or contraindications to oral feeding. It is often the final procedure for patients prior to placement or discharge. Delays in PEG placement lead to longer hospital stays and increased healthcare costs. We sought to evaluate the impact of a streamlined PEG placement algorithm on PEG wait times at a safety net hospital. Methods: On 1/7/22 at the Los Angeles County + University of Southern California (LAC + USC) Medical Center, our multidisciplinary team (Interventional Radiology (IR), Gastroenterology (GI) and Surgery) implemented an algorithm based on consensus criteria to clarify which PEG consults should be directed to GI versus IR (Figure 1A). Consults meeting GI criteria were staffed by one specific GI faculty member with 2 designated alternates to facilitate prompt PEG placement. If an endoscopy attending was unable to supervise, the PEG was placed by the specific attending that staffed the consult. An observational cohort of adult patients (>18 years) who received a PEG consult from the GI service from 7/1/21 to 5/21/22 was analyzed. The primary outcome of the study was the wait time (measured in business days) from consult to PEG placement pre-intervention (7/1/21 to 1/6/22) and post-intervention (1/7/22 to 5/21/22). Secondary outcomes were the relative proportion of successful PEG placements. Statistical analysis included Wilcoxon rank sum tests and logistic regression. Results: A total of 61 consults occurred during the study period, 33 prior to the intervention and 28 post-intervention. After the intervention was implemented, the mean wait time from consult to PEG placement decreased from 3.1 days to 1.0 days (P = .0002) (Figure 1B). Post-intervention, PEG placement was more likely following consultation (OR 5.7 [95% CI 1.1 - 28.8]) (Table 1) with no difference in placement success (OR 2.0 [95% CI 0.5 - 7.5]. Cohort characteristics were similar in both groups. During the study period, only one major complication was observed when a patient removed the PEG on post-procedure day one, causing peritonitis and required surgical intervention. Conclusion: Integration of a streamlined inpatient protocol significantly reduced wait times for PEG placement and increased probability of placement without differences in adverse outcomes. This specialized approach holds promise to improve inpatient care and reduce healthcare costs.Figure 1.: (A) PEG Placement Consult Algorithm. (B) Mean Wait Times from Consult to PEG Placement Pre- and Post-Intervention. Table 1. - Pre-Intervention (N=33) Post-Intervention (N=28) Total PEG Consults 33 28 Male 20 19 Female 13 9 Average Age (years) 54.4 56.8 Average Weight (kg) 71.9 73.1 Demographics Hispanic 12 21 Asian 8 3 African American 5 1 Caucasian 4 0 Unknown 4 3 Requesting indication Neurology 26 23 Pulmonary 6 4 Oncology 1 0 Burns 0 1 Total Planned PEG 22 26 Reason why PEG was not planned Deemed to not be medically optimized 6 0 Transferred to outside hospital 2 0 IR performed first 1 0 Obesity 1 0 Complex surgical or oncologic history 1 1 Ethics (no consent) 0 1