Managing patients with gastrostomy tubes in the community: Can a dedicated enteral feed dietetic service reduce hospital readmissions?

Abstract

BACKGROUND/OBJECTIVES: Post-gastrostomy complications range from 8 to 30%. These complications often occur following discharge into the community and may result in hospital readmission. Our unit previously reported a readmission rate of 23% in 6 months. There is a paucity of data evaluating community gastrostomy management. We therefore aimed to evaluate the benefits of a dedicated dietetic home enteral feed (HEF) team. SUBJECTS/METHODS: Demographic data, gastrostomy complications, readmission rates and HEF team input was prospectively collected from a cohort of discharged gastrostomy patients over a 1-year period and comparisons made with a similar historical cohort. RESULTS: A total of 371 complications were encountered in 313 gastrostomy patients during this period, with the commonest complication being over-granulated stoma sites (27%). Of these, 227 hospital admissions were avoided because of direct actions taken by the HEF team. Fifty-nine gastrostomy patients were admitted to the hospital, of which only seven (12%) were specifically for gastrostomy-related problems. Introduction of the HEF team significantly reduced gastrostomy-related hospital readmissions from 23 to 2% (P ¼ 0.0001). CONCLUSION: Although patients with gastrostomies may need attention to a variety of complex medical problems, many encounter problems specifically related to their gastrostomy after discharge. This is the largest prospective study demonstrating how dietitians trained in gastrostomy aftercare may optimize the management of gastrostomy complications and reduce unnecessary hospital readmissions.

Patients’ perspectives of living with a percutaneous endoscopic gastrostomy (PEG)

“…There are several ways to improve the life of patients living with a PEG. Kurien et al shows in a large prospective study that dietetic aftercare community service reduce hospital readmissions [32]. This is not surprisingly since Brotherton et al found in semi-structured interviews with PEG patients that issues that was emergent related to the enteral feeding were disturbed sleep, limited ability to go out, limited choice of clothing, difficulties finding feeding places.…”

Características diferenciales de los pacientes del Grupo Relacionado con el Diagnóstico (GRD) 541 que reingresan

“…Hemos observado que ser portador de gastrostomía implica un mayor riesgo de reingreso, a diferencia de lo observado con sonda nasogástrica. Este hallazgo se puede considerar como un marcador de mayor deterioro físico, aunque también podría interpretarse que un procedimiento que se efectúa como solución a un problema puede convertirse en una fuente de comorbilidad 14 .…”

Impact of direct drug delivery via gastric access devices

“…Of these, tube occlusion is one of the most common delayed complications seen, usually incurred as a consequence of drugs or enteral feeds [64,65]. Failure to recognize and instigate prompt treatment for this problem can lead to delays in feeding and receiving medication, as well as more serious complications such as peritonitis, infection, bleeding and possibly death.…”