754 - Using Quality Improvement to Reduce Overmedicalization in Inpatients with Disorders of Gut Brain Interaction

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 754
Publication Number: 754.119

Michelle Dunn, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Margo Szabo, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Rachel Waimberg, Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, United States; Bridget K. Rauch, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Jennifer Webster, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Presenting Author(s)

Michelle Dunn, MD (she/her/hers)

Clinical Assistant Professor of Pediatrics
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania, United States

Background: Pediatric disorders of gut brain interaction (DGBIs) are associated with psychosocial morbidity and high healthcare utilization. Recent literature supports an interdisciplinary approach to inpatient assessment, education, and treatment while decreasing medical interventions for pediatric somatic symptom disorders, including DGBIs.

Objective: Using quality improvement methodology, we aimed to develop an interdisciplinary inpatient care plan for pediatric patients with DGBIs to reduce central line use from a baseline of 35% of central line days per inpatient days in our cohort to less than 30% by December 31, 2022.

Design/Methods: We convened an interdisciplinary team to study and improve inpatient care for patients with DGBI. We developed and implemented four interventions: an electronic health record order set, scripted interdisciplinary family meeting, family education handout, and nursing and provider handoff reminders. Our primary outcome measure was central line use, with a process measure of order set usage, and balancing metric was length of stay. 

Results: The project bundle went live in January of 2022. The rate of central line days for cohort admissions decreased from 35% at baseline (1/2021-12/2021) to 23% since interventions were implemented (1/2022-12/2022) (Figure 1). Order set usage was suboptimal (less than one third of admissions.); and length of stay remained stable. We also received overwhelmingly positive feedback from various stakeholders, including inpatient staff and families. 

Conclusion(s): Our results suggest an interdisciplinary inpatient program decreases medicalization and supports behavioral health care access for pediatric DGBIs, preventing life threatening complications of central lines such as clots and infections. Current work includes expansion of our interventions to reach inpatients with DGBIs earlier in their disease course to prevent overmedicalization. 