Development and evaluation of a home enteral nutrition team.
The organisation of services to support the increasing number of people receiving enteral tube feeding (ETF) at home varies across regions. There is evidence that multi-disciplinary primary care teams focussed on home enteral nutrition (HEN) can provide cost-effective care. This paper describes the development and evaluation of a HEN Team in one UK city. A HEN Team comprising dietetians, nurses and a speech and language therapist was developed with the aim of delivering a quality service for people with gastrostomy tubes living at home. Team objectives were set and an underpinning framework of organisation developed including a care pathway and a schedule of training. Impact on patient outcomes was assessed in a pre-post test evaluation design. Patients and carers reported improved support in managing their ETF. Cost savings were realised through: (1) prevention of hospital admission and related transport for ETF related issues; (2) effective management and reduction of waste of feed and thickener; (3) balloon gastrostomy tube replacement by the HEN Team in the patient's home, and optimisation of nutritional status. This service evaluation demonstrated that the establishment of a dedicated multi-professional HEN Team focussed on achievement of key objectives improved patient experience and, although calculation of cost savings were estimates, provided evidence of cost-effectiveness.
University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, SO16 6YD, UK. sarah.dinenage@nhs.net.
Sarah
S
Dinenage
Solent NHS Trust, Adelaide Health Centre, Western Community Hospital Campus, Southampton, SO16 4XE, UK. morwenna.gower@solent.nhs.uk.
Morwenna
M
Gower
Nutricia Ltd., Trowbridge, Wiltshire, BA14 0XQ, UK. Johanna.vanwyk@nutricia.com.
Joanna
J
Van Wyk
University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, SO16 6YD, UK. anne.blamey@uhs.nhs.uk.
Anne
A
Blamey
University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, SO16 6YD, UK. Karen.ashbolt@uhs.nhs.uk.
Karen
K
Ashbolt
University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, SO16 6YD, UK. michelle.sutcliffe@nhs.net.
Michelle
M
Sutcliffe
Solent NHS Trust/University of Southampton, Highfield, Southampton, SO17 1BJ, UK. S.M.Green@soton.ac.uk.
Sue M
SM
Green
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004750:Enteral Nutrition / Q000191:economics / Q000379:methods; D005774:Gastrostomy; D006296:Health Services / Q000191:economics / Q000592:standards*; D006699:Home Care Services / Q000191:economics / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D009752:Nutritional Status; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000191:economics / Q000592:standards*; D006113:United Kingdom; D055815:Young Adult