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Clinical Session Proposals

Central Nervous System

Session Name: Practical and Ethical Issues for Swallow Recovery in Rehabilitation Planning: Dysphagia and Discharge Delays

2 - Implementing a Program for Admitting Patients with Nasogastric Tubes to Inpatient Rehab

Thursday, October 20, 2022

2:00 PM – 3:15 PM ET

Location: 345-346

Speaker(s)

Krishnaj Gourab, MD

Chief Medical Officer
UM Rehab & Ortho Institute
Baltimore, Maryland

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

For patients with stroke-related dysphagia, nasogastric (NGT) feeding (instead of PEG tube feeding) should be the chosen route for the first 2-3 weeks. Keeping patients in the acute care hospital for this duration would increase the length of stay in acute care. There is variation in practice (in regards to admitting patients with NGT) at inpatient rehabilitation facilities (IRF) and sub-acute rehabilitation facilities. Thus, patients with prolonged dysphagia and NGTs often have difficulty finding a facility to start their post-acute rehabilitation care. They also have difficulty finding adequate home support for a safe discharge. We implemented a novel program for admitting stroke patients with NGTs to our IRF. The majority of these patients recovered swallow function before discharge from IRF (and did not need a PEG tube). Implementation and change management for this program is discussed.

Learning Objectives:

Describe how evidence-based recommendations for timing of PEG placement in stroke patients vs. expectation of managing ALOS may be at odds
Describe an example of leveraging system resources across the continuum to deliver evidence-based care within operational constraints
List at least two change management frameworks
Recognize that drift is expected if education alone (and not hardwiring) is relied upon to sustain change.