S1272 Impact of Institutional Enteral Feeding Tube Policy on Medical Nutrition Utilization

Abstract

INTRODUCTION: Neurodegenerative diseases (ND) are a group of diseases affecting brain neurons. Patients with ND have difficulty self-feeding1. Enteric feeding tubes, including Percutaneous endoscopic gastrostomy (PEG) tubes are placed for patients at risk for severe malnourishment. There is extensive evidence showing PEG placement is associated with increased complications and provides no mortality or palliation benefit2. In 2017 NYU Winthrop Hospital implemented a policy where patients with ND require a palliative care consultation prior to enteric tube placement. This study was performed to determine if implementation of the hospital policy had a significant effect on the number of PEG tubes placed in patients with ND. METHODS: All patients who received an enteral feeding tube were studied. The number and percentage of PEG tubes to total enteral tubes placed in patients with ND between the years 2017 (before hospital policy implementation) and 2018 (after hospital policy implementation) were compared. PEG placement percentages were compared between patients with ND who received Palliative Care (PC) consult and those who did not to examine if there is a correlation between PC consult and decrease in PEG placement. Categorical data was compared via Fisher’s exact test. Binomial percentages were computed along with 95% exact confidence intervals. SAS 9.4 was used for all analyses. RESULTS: In 2017, 70.5% (241/342) subjects had PEG tubes placed compared to 67.1% (177/264) in 2018 (P = 0.377) which represented no significant difference. There were 84 Patients who had ND and PEG placed. Among patients who had PEG placed, 20.6% (48/233) had neurodegenerative disease in 2017 compared to 20.5% (36/176) in 2018, P = 1.00 which represented no significant difference. There was a significant reduction in overall enteral feeding tube placement in patient who received PC consult compared to those who did not [56.6% vs. 89.0%, Odds Ratio(95% CI) = 0.16(0.10–0.25), < 0.0001]. CONCLUSION: There was no statistical significance in the number tubes placed in patients with ND after the policy was implemented. These findings were due to incomplete compliance with or knowledge of the policy. There was a significant reduction in enteral tube placements in patients who received palliative care consults. Palliative care consultation appears to be an important component of the policy. We suggest discussions to broaden the scope of this policy to impact patients with other medical conditions who are the end of life.