title: Implementation of a dietitian-led enteral nutrition support clinic results in quality improvement, reduced readmissions, and cost savings.
abstract: BACKGROUND
  Enteral access device malfunction and breakage results in significant morbidity and healthcare cost. In many healthcare systems, enteral nutrition care is fragmented and inefficient. We describe the development and validation of an enteral nutrition support clinic (NSC) with a focus on prevention of enteral access complications. A care protocol consisting of pre- and postplacement visits and subsequent weekly visits was developed. Competencies were established for dietitians to staff the NSC.
  
  
  METHODS
  A retrospective quality analysis was performed in patients before and after the implementation of an enteral NSC. Enteral access complications, emergency room visits, readmissions, unplanned physician visits, and tube replacements were recorded for 90 days after tube placement.
  
  
  RESULTS
  Thirty patients were evaluated in the NSC pilot and compared with 22 baseline patients with adequate follow-up. The NSC resulted in an 88.9% reduction in nutrition-related emergency room visits (P = .016) and 78.1% reduction in readmissions (P = .027). Estimated per-patient cost reductions amounted to $6831. Approximately 30% of patients were seen in the NSC at least once for a clogged tube and 43.3% for tube leakage. Only 1 NSC patient required a procedure for tube reinsertion.
  
  
  CONCLUSIONS
  Implementation of a dietitian-led nutrition support clinic resulted in improved quality, as well as reductions in hospital readmissions, tube-related complications, and healthcare costs
authors.affiliation: Cancer Programs, Billings Clinic, Billings, Montana, USA.
authors.forename: Beth T
authors.initials: BT
authors.lastname: Hall
authors.forename: Michael S
authors.initials: MS
authors.lastname: Englehart
authors.forename: Karyl
authors.initials: K
authors.lastname: Blaseg
authors.forename: Kandis
authors.initials: K
authors.lastname: Wessel
authors.forename: Stanislaw P  A
authors.initials: SP
authors.lastname: Stawicki
authors.forename: David C
authors.initials: DC
authors.lastname: Evans
mesh_terms: D000554:Ambulatory Care Facilities; D002983:Clinical Competence; D002985:Clinical Protocols; D017046:Cost Savings; D004046:Dietetics; D004750:Enteral Nutrition / Q000009:adverse effects / Q000191:economics / Q000592:standards*; D004868:Equipment Failure; D005774:Gastrostomy; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000191:economics / Q000592:standards*; D064686:Nutritionists; D010359:Patient Readmission; D058996:Quality Improvement; D012189:Retrospective Studies