P1969 - Fast Track for Tube Delivery

Award: Presidential Poster Award

Award: Presidential Poster Award

Pamela Kim, MD, Marisa Isaacson, MD, Rita Cole, MBA, BS, Elie Aoun, MD, MS, Katie Farah, MD
Allegheny Health Network, Pittsburgh, PA

Introduction: Due to increased morbidity and mortality of inadvertent blind feeding tube placements, we implemented an enteral nutrition inpatient pilot at our tertiary care facility. We created a “tubes service” in an effort to provide more timely nutrition in a safe manner to improve quality of care. We aimed to reduce risk of adverse events as well as to provide more timely nutrition safely by also minimizing radiation from x-ray.

Methods: We piloted the enteral nutrition platform with GI fellow placement of NG/post pyloric feeding tubes under direct visualization without use of endoscopy for failed blind bedside NG placements. A data collection form was created to measure results (Figure1a). We incorporated the Resource Intensive Care (RIC) Nurses onto our team. GI provided an in-service for critical care staff on the enteral nutrition platform. The RIC Nurse service went live after each nurse was deemed competent based on a competency evaluation developed by the GI lead physician (Figure1b). Collaboration with IT Services for use of this platform to capture images of proper placement was confirmed for medical record documentation and for reduction of x-ray usage. GI will support failed attempts endoscopically.

Results: GI fellows placed 50 tubes with no adverse events from February 2020 – December 2020. This number excludes 3 months of the initial pandemic period and excluded COVID + patients. Average time from consult to placement was 9 hours compared to reported time from consult to blind placement averaging ~21 hours. From March –April 2021, 16 (100%) tubes were placed successfully in the ICUs by our dedicated RIC nurse team. One attempt was hindered due to hiatal hernia. Average times from consult to placement averaged 4 hours.

Discussion: Bedside placement of feeding tubes with built-in camera technology allows for a safer, more effective, and more efficient method for delivery of enteral nutrition for inpatients. A cost/benefit analysis shows a potential $840.20 in savings per patient with decreased need for x-rays, decreased risk of adverse events, earlier time to feeding and decreased length of stay. Out of 66 successful placements, it is an estimated total potential savings of $55,453. We will expand this service to other hospitals within our large health system to include COVID+ patients moving forward.


Figure: Figure 1a. Feeding Tube Data Collection
Figure 1b. Feeding Tube Insertion Competency Form
Feeding Tube Placement Results

	Time from Order to Tube Placement	Average Number of Attempts	Time from Order to Feeding
Blind Placements	21 hours	1-3
GI Fellows	8 hours 49 minutes	1.1	9 hours 40 minutes
Resource Intensive Care (RIC) Nurses	3 hours 57 minutes	1.3	9 hours 4 minutes

Disclosures:
Pamela Kim indicated no relevant financial relationships.
Marisa Isaacson indicated no relevant financial relationships.
Rita Cole: Cardinal Health – Grant/Research Support.
Elie Aoun indicated no relevant financial relationships.
Katie Farah: Cardinal Health – Grant/Research Support.


Pamela Kim, MD, Marisa Isaacson, MD, Rita Cole, MBA, BS, Elie Aoun, MD, MS, Katie Farah, MD. P1969 - Fast Track for Tube Delivery, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.