Effect of Standard Care Pathway Implementation on Clinical Outcomes and Protocol Utilization in Infants With Gastroschisis.

INTRODUCTION

Standardization of care is an important tool to improve healthcare value and patient outcomes. We created a multidisciplinary clinical care guideline for management of infants with gastroschisis. The aim of the current work is twofold: 1. Determine effectiveness of our implementation strategy and 2. Determine the association between guideline use and clinical outcomes.

METHODS

We conducted a retrospective review of infants diagnosed with gastroschisis at a single level IV NICU from 2010 to 2024. Provider utilization of four elements of the protocol (no elective intubation for sutureless closure or silo placement, no antibiotic prophylaxis with silo in place, central venous access within 48 h, selenium supplementation in TPN) were assessed. Patient outcomes and rates of complications were compared between pre- and post-protocol groups.

RESULTS

There were 126 infants included (n = 86 pre-protocol, n = 40 post-protocol). After adjusting for covariates, rate of antibiotic prophylaxis decreased (p < 0.001) and selenium supplementation in TPN increased (p = 0.002). Use of bedside silo and sutureless closure increased (p = 0.02, p < 0.001) with a corresponding decrease in operative fascial closure (p < 0.001). Time to feed initiation and exposure to general anesthesia decreased (p < 0.001, p < 0.001), though time to full feeds and hospital length of stay (LOS) increased (p < 0.001, p < 0.001). There were no differences in complication rates including infection, unplanned reoperation, and readmission between groups.

CONCLUSIONS

Implementation of a standardized pathway for infants with gastroschisis was associated with decreased antibiotic use and general anesthesia exposure without increasing rates of complications. Notably, time to achieve full feeds and hospital LOS increased, which are targets of future investigation.

TYPE OF STUDY: Retrospective cohort.

LEVEL OF EVIDENCE: III.