480 - Providing Anticipatory Guidance for Children with Gastrostomy Tubes: Impact of an online curriculum on resident documentation

Poster Number: 480
Publication Number: 480.421

Emily J. Goodwin, Children's Mercy Kansas City, Kansas City, MO, United States; Maria Johnson, Children's Mercy Hospitals and Clinic, Platte City, MO, United States; Elizabeth Rhyne, University of Missouri-Kansas City School of Medicine, Lee's Summit, MO, United States; Evan Weber, Southeast Health, Cape Girardeau, MO, United States; Elena Huang, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Robert Riss, UMKC, Shawnee, KS, United States; Matt Hall, Children's Hospital Association, Lenexa, KS, United States; Jeffrey D. Colvin, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States

Background: Children with medical complexity (CMC) often rely on medical devices, most commonly gastrostomy tubes (GT), and benefit from proactive anticipatory guidance (AG). Few curricula have been developed to train residents in examining and providing appropriate anticipatory guidance for CMC with gastrostomy tubes.

Objective: To examine the impact on resident documentation of an asynchronous online curriculum for providing anticipatory guidance for children with GT or gastrojejunostomy (GJ) tubes.

Design/Methods: Informed by the results of a needs assessment, we designed and implemented an online asynchronous curriculum for pediatric residents at a large free-standing children’s hospital. The course included online modules and downloadable toolkits with sample phrases for documenting physical exam findings and AG. We reviewed resident documentation pre- and post-curriculum of patients with G or GJ tubes seen in the emergency department, primary care clinic, or an inpatient setting. Linear regression was used to assess pre-post changes in resident documentation of GT exam and AG while adjusting for visit type, reason for visit and patient age.

Results: A total of 57 (76%) residents who completed the curriculum and consented for inclusion in the study had pre- and post-curriculum encounters. Patients were similar pre- and post-curriculum (Table 1).  The majority of visits were inpatient (54.8%) and non-GT related (87.3%). After the curriculum, residents were significantly more likely to document appropriate elements of a GT exam compared to pre-curriculum, but there were no differences in the provision of written AG (Table 2). Residents were 15 times more likely to provide written g-tube anticipatory guidance if the reason for the visit was GT related. These differences did not persist in adjusted analyses, but exams in the post-period approached significance with 0.30 additional g-tube items (0.30 [95% CI: -0.01, 0.62] p=0.06) (Table 3).

Conclusion(s): After completion of the curriculum, resident documentation of GT exam findings approached significant increases while provision of written AG was not significantly different. Future studies should consider how to assess verbal anticipatory guidance and what the caregivers of children with gastrostomy tubes want and need from anticipatory guidance.