Prospective, randomized, controlled, single-blind trial of the costs and consequences of systematic nutrition team follow-up over 12 mo after percutaneous endoscopic gastrostomy

Scott, Fiona; Beech, Roger; Smedley, F; Timmis, Lynne; Stokes, Elizabeth A; Jones, Peter W.; Roffe, Christine; Bowling, Tim

doi:10.1016/j.nut.2005.03.004

Cited by 43 publications

(71 citation statements)

References 5 publications

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“…This finding was confirmed at a university teaching hospital [197] . In addition, cost-utility analyses of patients receiving ETF either as hospitalized patients or as outpatients have demonstrated a significant lowering of healthcare costs through the reduction of metabolic and mechanical complications [198][199][200][201] .…”

Section: Role Of Nutrition Support Teamsmentioning

confidence: 99%

Gastroenteric tube feeding: Techniques, problems and solutions

Blumenstein

Shastri

Stein

2014

WJG

351

288

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Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction, and patients who are critically ill. However, despite the benefits and widespread use of enteral tube feeding, some patients experience complications. This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding, together with associated complications and special aspects. We conducted an extensive literature search on PubMed, Embase and Medline using index terms relating to enteral access, enteral feeding/nutrition, tube feeding, percutaneous endoscopic gastrostomy/jejunostomy, endoscopic nasoenteric tube, nasogastric tube, and refeeding syndrome. The literature showed common routes of enteral access to include nasoenteral tube, gastrostomy and jejunostomy, while complications fall into four major categories: mechanical, e.g., tube blockage or removal; gastrointestinal, e.g., diarrhea; infectious e.g., aspiration pneumonia, tube site infection; and metabolic, e.g., refeeding syndrome, hyperglycemia. Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route, gastrointestinal complications are without doubt the most common. Complications associated with enteral tube feeding can be reduced by careful observance of guidelines, including those related to food composition, administration rate, portion size, food temperature and patient supervision.

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Section: Role Of Nutrition Support Teamsmentioning

confidence: 99%

Gastroenteric tube feeding: Techniques, problems and solutions

Blumenstein

Shastri

Stein

2014

WJG

351

288

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“…1,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] Four studies applied to unique populations. 2,3,75,76 Twenty-nine studies were based in the United States, while the rest were in other nations. eTables 2 to 6 in the Supplement include setting and academic status.…”

Section: Population and Contextmentioning

confidence: 99%

Economic Evaluation of Quality Improvement Interventions Designed to Prevent Hospital Readmission

et al. 2017

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IMPORTANCE Quality improvement (QI) interventions can reduce hospital readmission, but little is known about their economic value. OBJECTIVE To systematically review economic evaluations of QI interventions designed to reduce readmissions. DATA SOURCES Databases searched included PubMed, Econlit, the Centre for Reviews & Dissemination Economic Evaluations, New York Academy of Medicine's Grey Literature Report, and Worldcat (January 2004 to July 2016).STUDY SELECTION Dual reviewers selected English-language studies from high-income countries that evaluated organizational or structural changes to reduce hospital readmission, and that reported program and readmission-related costs.DATA EXTRACTION AND SYNTHESIS Dual reviewers extracted intervention characteristics, study design, clinical effectiveness, study quality, economic perspective, and costs. We calculated the risk difference and net costs to the health system in 2015 US dollars. Weighted least-squares regression analyses tested predictors of the risk difference and net costs. MAIN OUTCOMES AND MEASURESMain outcomes measures included the risk difference in readmission rates and incremental net cost. This systematic review and data analysis is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTSOf 5205 articles, 50 unique studies were eligible, including 25 studies in populations limited to heart failure (HF) that included 5768 patients, 21 in general populations that included 10 445 patients, and 4 in unique populations. Fifteen studies lasted up to 30 days while most others lasted 6 to 24 months. Based on regression analyses, readmissions declined by an average of 12.1% among patients with HF (95% CI, 8.3%-15.9%; P < .001; based on 22 studies with complete data) and by 6.3% among general populations (95% CI, 4.

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“…The decision requires contributions from several different clinical disciplines as well as consideration of psychological, social and ethical factors. For these reasons, the decision-making process should involve a multidisciplinary team 1 7. Evidence suggests that complications related to tube feeding are less common in hospitals where a multidisciplinary nutrition team functions 8.…”

Section: Service Organisationmentioning

confidence: 99%

The provision of a percutaneously placed enteral tube feeding service

Westaby

Young

O'Toole

et al. 2010

Gut

108

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There is overwhelming evidence that the maintenance of enteral feeding is beneficial in patients in whom oral access has been diminished or lost. Short-term enteral access is usually achieved via naso-enteral tube placement. For longer term tube feeding there are recognised advantages for enteral feeding tubes placed percutaneously. The provision of a percutaneous enteral tube feeding service should be within the remit of the hospital nutrition support team (NST). This designated team should provide a framework for patient selection, pre-assessment and post-procedural care. Close working relations with community-based services should be established. An accredited therapeutic endoscopist should be a member of the NST and direct the technical aspects of the service. Every endoscopy unit in an acute hospital setting should provide a basic percutaneous endoscopic gastrostomy (PEG) service. This should include provision for fitting a PEG jejunal extension (PEGJ) if required. Specialist units should be identified where a more comprehensive service is provided, including direct jejunal placement (DPEJ), as well as radiological and laparoscopically placed tubes. Good understanding of the indications for percutaneous enteral tube feeding will prevent inappropriate procedures and ensure that the correct feeding route is selected at the appropriate time. Each unit should adopt and become familiar with a limited range of PEG tube equipment. Careful adherence to the important technical details of tube insertion will reduce peri-procedural complications. Post-procedural complications remain relatively common, however, and an awareness of the correct approach to managing them is essential for all clinicians involved in providing a percutaneous enteral tube feeding service. Finally, ethical considerations should always be taken into account when considering long-term enteral feeding, especially for patients with a poor quality of life.

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Prospective, randomized, controlled, single-blind trial of the costs and consequences of systematic nutrition team follow-up over 12 mo after percutaneous endoscopic gastrostomy

Cited by 43 publications

References 5 publications

Gastroenteric tube feeding: Techniques, problems and solutions

Gastroenteric tube feeding: Techniques, problems and solutions

Economic Evaluation of Quality Improvement Interventions Designed to Prevent Hospital Readmission

The provision of a percutaneously placed enteral tube feeding service

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