Clinical Nutrition Open Science (Oct 2023)
Service improvement for a dietetic-led radiologically inserted gastrostomy service using the Plan-Do-Study-Act (PDSA) cycle
Abstract
Summary: Background: A dietetic-led gastrostomy tube service can improve patient outcomes and reduce hospital costs. This project aimed to update and evaluate a well-established dietetic-led pre radiologically inserted gastrostomy (RIG) insertion risk assessment and assess the impact on insertion delays and complication-risk in patients with head and neck cancer (HNC) attending a tertiary UK centre. Methods: The Plan-Do-Study-Act (PDSA) cycle guided the evaluation and improvement of the dietetic-led pre-RIG insertion risk assessment. Benchmarking and stakeholder involvement was conducted before service changes were implemented. A major change to the updated risk assessment removed the mandatory requirement for two weeks of naso-gastric (NGT) feeding prior to RIG insertion for malnourished patients, and changed this to dietitian clinical judgement. A pre- and post- implementation service evaluation was conducted to assess the impact of these changes. Results: Thirty-three patients underwent RIG placement from January 2018 to August 2021. 15 were screened against the pre-implementation risk assessment and 18 against the post-implementation risk assessment. 66.7% patients were male (n=22) with a median age of 62 years (range 20–85 years). Ten malnourished patients (30.3%) required 2 weeks of NGT feeding prior to RIG placement (n=7 in the pre-implementation group; n=3 in the post-implementation group). 7 patients sustained a major RIG complication, higher in the pre-implementation (n=6) than the post-implementation group (n=1). Conclusion: Removal of mandatory NGT feeding in a dietetic-led RIG insertion risk assessment was accepted by the multidisciplinary team after a trial into standard practice. Further research should assess the suitability of this risk assessment in other centres, and impact on cost-savings associated with reducing insertion delays and implementing dietetic led-screening.
