Practice Management

68 - Effect of a Team-Based Approach to Improve Enteral Access Decision-Making

Wednesday, October 10
9:00 AM - 9:10 AM
Location: Terrace Ballroom 2-3 (level 400)

Category: Practice Management
Jannie Tran, PA-C1, Jessica Kimmel, MD1, Andrea Betesh, MD2, Melissa Latorre, MD, MS1, Andrew Dikman, MD1, Brigette Cohan, BA1, Savita Seeriram-Saine, ANP1, Brian P. Bosworth, MD, FACG3
1NYU Langone Health, New York, NY; 2Weill Cornell Medicine, New York, NY; 3NYU Langone Tisch Hospital, New York, NY

Introduction: According to the American Society for Gastrointestinal Endoscopy, percutaneous endoscopic gastrostomy tube placement is recommended when enteral nutrition is needed for 30 days or more. This is associated with an up to 4% rate of severe complications. Weighted nasogastric tubes (NGT) are an alternative when less than 30 days of enteral access are needed. However, this too is not without risk and may result in a pneumothorax. Too many potentially harmful interventions are provided to patients at end-of-life. The Enteral Access Team (EAT), a multidisciplinary team, was created to reduce unnecessary feeding tubes placements at the end-of-life, minimize associated complications from gastrostomy (G-tube) and NGT and to counsel patients regarding enteral access. This study aimed to look at the effects of the EAT during the first 5 months of implementation.

Methods: Following the initiation of tEAT, a quality improvement database was created capturing tge enteral access requested and obtained, predicted survival of less than 6 months and complications. Observed to expected length of stay, readmission rates and discharged rates to home were compared between patients who did and did not receive G-tubes.

Results: From 11/1/2017 to 4/1/2018, G-tubes were requested for 49 patients. Thirty-two patients (65%) underwent G-tube placement. 17 patients (35%) did not have a G-tube placed. Patients at end-of-life within 6 months accounted for 94% of those who did not have a G-tube placed and 42% of those who did.

Data through 2/2018 showed that the observed to expected length of stay for patients who received a G-tube was 1.66 compared to 1.05 for those who did not receive one. This corresponded to a 58% variance in observed to expected length of stay between the two groups. Readmission rates analyzed up to January 2018 showed a 14% readmission rate for patients who had G-tubes placed compared to a 0% readmission rate for those without placement. In cases where a G-tube was placed 19% of patients were discharged home compared to 24% for those without placement. Overall, this corresponded to a 35% variable cost reduction per case when a G-tube was not placed. There were no observed pneumothoraces as a result of weighted NGT placement by EAT providers.

Discussion: EAT has reduced the rate of G-tube placement at end-of-life, resulting in improved appropriateness of gastrostomy placement, reduced length of stay, reduced readmission rates and variable cost in the end-of-life population.

Table 1. In the 49 patients of which gastrostomy tubes were requested, the observed to expected length of stay, percentage of patients discharged home, and readmission rate was compared between two groups: patients who had a gastrostomy tube placed and patients who did not receive a gastrostomy tube.

Disclosures:
Jannie Tran indicated no relevant financial relationships.
Jessica Kimmel indicated no relevant financial relationships.
Andrea Betesh indicated no relevant financial relationships.
Melissa Latorre indicated no relevant financial relationships.
Andrew Dikman indicated no relevant financial relationships.
Brigette Cohan indicated no relevant financial relationships.
Savita Seeriram-Saine indicated no relevant financial relationships.
Brian Bosworth indicated no relevant financial relationships.

Jannie Tran

Physician Assistant
NYU Langone Health
New York, New York

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