Interventions included hiring staff to play with patients and adding new play spaces
Maryland Heights, Mo. (Feb. 17, 2025) – St. Louis-based Ranken Jordan Pediatric Bridge Hospital has reduced tube dislodgements by nearly 50 percent after implementing a series of play-based interventions designed to improve health outcomes for medically complex children.
The results stem from an initiative to address tube dislodgements, a common but serious issue in pediatric hospitals that can lead to life-threatening consequences. When a tracheostomy tube becomes dislodged, it constitutes a medical emergency, requiring immediate intervention. Sometimes tubes fall out by accident, but young children often pull them out for attention.
Ranken Jordan serves a high proportion of children with tracheostomies (trachs) and feeding tubes, including gastrostomy (g-tubes) and jejunostomy tubes (j-tubes).
To tackle the tube dislodgement issue, hospital leadership set up the Tube Dislodgement Working Group in 2022 to develop targeted solutions while keeping the hospital’s unique care model, Care Beyond the Bedside®, at the heart of the interventions.
“Many acute care hospitals rely on constant bedside monitoring to prevent tube dislodgement,” said Nick Holekamp, MD, Chief Healthcare Transformation Officer at Ranken Jordan. “But our care model is focused on getting children out of their hospital rooms, so we needed solutions to keep kids active and mobile, prioritizing time to let them just be kids.”
Ranken Jordan’s lead pediatric psychologist Claire Wallace, PhD, summarized the outcomes associated with several key interventions. The most effective included:
Bedside debriefs - Following every tube dislodgement, involved team members immediately discussed contributing factors and how to prevent it in the future.
Introduction of the Patient Play Associate (PPA) role - In 2023, Ranken Jordan introduced PPAs, a paid position dedicated to getting kids out of their hospital beds to play.
Revisions to feeding backpack use - The Ranken Jordan team found a way to decrease excess tube slack in feeding backpacks to reduce accidental dislodgement.
A tiered response system - To avoid encouraging attention-seeking behavior from younger patients, the team created a tiered protocol outlining behavioral guidance for children who frequently pulled at their tubes.
Creation of “play corrals” - In 2024, Ranken Jordan converted nursing stations into “play corrals,” similar to playpens, to create safe, engaging play areas for younger patients outside of their rooms.
Wallace presented the results of the initiative at the American Academy for Cerebral Palsy and Developmental Medicine’s 79th Annual Meeting in 2025, and additional team members shared the work at the 2025 Pediatric Complex Care Association Annual Meeting.
“The findings from this initiative are a tangible example of the power of play, which is at the core of our Care Beyond the Bedside model,” Dr. Wallace said. “When I presented the results, I was inundated with questions and enthusiasm from people at other hospitals who take care of patients like ours. We are excited to share our innovative work with the wider healthcare community and we are hopeful other hospitals will implement similar interventions when possible.”
Sharing innovations fueled by Care Beyond the Bedside is a strategic priority for Ranken Jordan. In 2025, the hospital announced its new research department, a rarity in a hospital of Ranken Jordan’s size. Longtime Chief Medical Officer Dr. Holekamp was appointed the hospital’s first Chief Healthcare Transformation Officer and is now dedicated to driving transformative and systemic change in pediatric healthcare for children with complex medical needs.
“We want to help as many medically complex children as possible, whether they’re at our hospital or not,” Holekamp added. “We will continue to share results from our work because the outcomes we’re seeing reinforce what we’ve believed for years: when play is central to care, children experience better health outcomes.”
To learn more about Ranken Jordan and its research, visit RankenJordanFoundation.org.
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Media Contact: Haley Raymond, Leigh Walters Communications, HaleyR@lwcstrategies.com
Ranken Jordan
Ranken Jordan is a pediatric bridge hospital that cares for kids from birth to 21 who are well enough to leave a traditional hospital but need help before they go home. The only hospital of its kind in Missouri and one of only a select few in the country, Ranken Jordan specializes in caring for children and their families with the most complex conditions, illnesses and injuries, bridging the gap between hospital and home. The 60-bed hospital uses an innovative care model, Care Beyond the Bedside, which gets children out of their hospital rooms, activating the healing power of play. Located in the heart of the Midwest, Ranken Jordan serves patients from across the region at its state-of-the-art facility.
