Impact of Multidisciplinary Standardization of Care for Gastroschisis: Treatment, Outcomes, and Cost

Background/Purpose: Elimination of unnecessary practice variation through standardization creates opportunities for improved outcomes and cost-effectiveness. A quality improvement (QI) initiative at our institution used evidence and consensus to standardize management of gastroschisis (GS) from birth to discharge. Methods: An interdisciplinary team utilized best practice evidence and expert opinion to standardize GS care. Following stakeholder engagement and education, care standardization was implemented in September 2014. A comparative cohort study was conducted on consecutive patients treated before (n = 33) and after (n = 24) standardization. Demographic, treatment, and outcome measures were collected from a prospective GS registry. Direct costs were estimated, and protocol compliance was audited. Results: BW, GA, and bowel injury severity were comparable between groups. Key practice changes were: closure technique (pre-88% primary fascial, post-83% umbilical cord flap; p < 0.001), closure location (pre-97% OR, post-67% NICU; p < 0.001), and GA avoidance (pre-0%, post-48%; p < 0.001). Median post-closure ventilation days were shorter (pre-4, post-1; p < 0.001), and SSI rates trended lower (pre-21%, post-8%;p = 0.3) in the post-implementation group with no differences in TPN days or LOS. No significant difference was seen in average per-patient costs: pre-$85,725 ($29,974-221,061), post-$76,329 ($14,205-176,856). Conclusion: Care standardization for GS enables practice transformation, cost-effective outcome improvement, and supports an organizational culture dedicated to continuous improvement. Level of Evidence: III. (C) 2018 Elsevier Inc. All rights reserved.