QI in Action: Reducing Unwarranted Variation in Care for Patients with Gastrostomy Feeding Devices

We spotlight Adina Quattrini’s project to reduce unplanned consultations for patients with gastrostomy feeding devices by standardising care pathways and improving outcomes.

The ACHS Improvement Academy’s Quality Improvement Lead (QIL) Program supports healthcare professionals in implementing data-driven improvement initiatives within their organisations.

QIL Graduate, Ms Adina Quattrini’s project titled, ‘Care Pathway for Patients with Gastrostomy Feeding Devices Referred to the Percutaneous Endoscopic Gastrostomy Clinic,’ aimed to reduce the number of unplanned or unscheduled consultations for patients with gastronomy feeding tubes Percutaneous Endoscopic Gastrostomy Clinic at Fiona Stanley Fremantle Hospital.

Fiona Stanley Fremantle Hospitals Group delivers hospital and community-based public health to a population of more than 698,616 across the southern half of Perth. Services at Fiona Stanley Fremantle Hospitals Group comprise of Fiona Stanley Hospital, Fremantle Hospital and Rottnest Island Nursing Post.

Project Background

Patients with gastrostomy feeding tubes referred to the Percutaneous Endoscopic Gastrostomy (PEG) Clinic were experiencing a growing number of unplanned or unscheduled consultations. This trend placed pressure on the Clinical Nurse Specialist (CNS) role in endoscopy and was affecting the ability of staff to manage other tasks.

The aim of this quality improvement project was to reduce unplanned consultations by 25% within six months, while ensuring patients received the right care, at the right place, at the right time.

Identifying Reasons for Unplanned Consultations

Data from the PEG Clinic highlighted a steady increase in consultations over three year. Interviews and process mapping revealed variability in care pathways across specialties, leading to inconsistent patient experiences. Data revealed that top reasons for outpatient consultations were for a review, while patients with a Percutaneous Endoscopic Gastro-Jejunostomy were due to a blocked PEGJ.

The team developed a driver diagram focused on standardising processes and reducing variability of care to improve outcomes. This included:

Standardising referral and discharge processes

Improving patient and carer readiness for self-management

Training staff to align with best practice standards

Refining data collection to ensure accurate monitoring of outcomes

Project Results

Key early successes included adding the PEG Clinic CNS as an option on the e-referral system, improving timely access to referrals. The uptake of e-referrals has improved the triage process, enabling patient needs to be appropriately captured. The ongoing process improvement is focusing on development of resources, alongside further collaborative engagement of staff and patients.

Explore projects from QIL Program Graduates
You can read more projects like this in the QIL Projects Summary booklet undertaken by QIL 2021-2023 participants over the course of our 9-month program.

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