title: Managing patients with gastrostomy tubes in the community: can a dedicated enteral feed dietetic service reduce hospital readmissions?
abstract: OBJECTIVE
  Post-gastrostomy complications range from 8 to 30%. These complications often occur following discharge into the community and may result in hospital readmission. Our unit previously reported a readmission rate of 23% in 6 months. There is a paucity of data evaluating community gastrostomy management. We therefore aimed to evaluate the benefits of a dedicated dietetic home enteral feed (HEF) team.
  
  
  METHODS
  Demographic data, gastrostomy complications, readmission rates and HEF team input was prospectively collected from a cohort of discharged gastrostomy patients over a 1-year period and comparisons made with a similar historical cohort.
  
  
  RESULTS
  A total of 371 complications were encountered in 313 gastrostomy patients during this period, with the commonest complication being over-granulated stoma sites (27%). Of these, 227 hospital admissions were avoided because of direct actions taken by the HEF team. Fifty-nine gastrostomy patients were admitted to the hospital, of which only seven (12%) were specifically for gastrostomy-related problems. Introduction of the HEF team significantly reduced gastrostomy-related hospital readmissions from 23 to 2% (P = 0.0001).
  
  
  CONCLUSIONS
  Although patients with gastrostomies may need attention to a variety of complex medical problems, many encounter problems specifically related to their gastrostomy after discharge. This is the largest prospective study demonstrating how dietitians trained in gastrostomy aftercare may optimize the management of gastrostomy complications and reduce unnecessary hospital readmissions.
authors.affiliation: Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Sheffield, UK. matthew.kurien@sth.nhs.uk
authors.forename: M
authors.initials: M
authors.lastname: Kurien
authors.forename: S
authors.initials: S
authors.lastname: White
authors.forename: G
authors.initials: G
authors.lastname: Simpson
authors.forename: J
authors.initials: J
authors.lastname: Grant
authors.forename: D S
authors.initials: DS
authors.lastname: Sanders
authors.forename: M E
authors.initials: ME
authors.lastname: McAlindon
mesh_terms: D000328:Adult; D000368:Aged; D004046:Dietetics; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006097:Granulation Tissue; D006296:Health Services; D006801:Humans; D015994:Incidence; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012111:Residence Characteristics