ABSTRACT
INTRODUCTION: Roughly 1.2M feeding tubes are placed annually in the US, most of which are placed without direct visualization. The current state within our Network is blind bedside placement with x-ray confirmation. The cost of blind placement is $1.46M annually, with potential additional cost due to complications (airway placement, pneumothorax, death), delayed nutrition/administration of medications, and cost of x-ray. We identified 3 adverse events which occurred over a 3-year time period with blind placement, resulting in 2 deaths and 1 lung placement. Sub-specialty departments have expressed frustration for lack of a "tubes service" in an effort to provide more timely nutrition in a safe manner as well as avoid need for x-rays. METHODS: In an effort to improve quality of care to patients, optimize time to tube placement, and ensure accurate placement eliminating need for x-rays, an enteral nutrition platform was implemented with GI fellow training and placement of NG and post-pyloric tubes under direct visualization without the use of endoscopy. The inpatient service received consults for failed bedside NG placements via a specific EPIC order set. Each fellow was required to participate in a demo on proper device use and per form 2 live placements with industry and lead physician providing atelbow assistance. The Program Director developed an instruction sheet which was made a part of the curriculum, Figure 1. with the first 50 placements to be confirmed by x-ray. RESULTS: The service began in February 2020 and 10 consults had been received thus far. The GI fellows achieved a 100% success using tube with direct visualization. X-ray confirmed proper placement with no adverse events. Average time from consult to placement was 10 hours and time from consult to use was less than 24 hours, Figure 2. Xinying et al reported time from consult to blind placement was an average of ;21 hours. Given the COVID-19 pandemic, fellow training was halted and 2 competent fellows continued to place tubes eliminating the need for transport and x-ray during that critical time. CONCLUSION: The tube service was well accepted in our hospital. An initial cost/benefit analysis shows a potential $840.20 in savings per patient (Table 1) with decreased need for x-rays, elimination of adverse events as direct visual capability, earlier time to feeding and decreased length of stay. Further cost/benefit will be analyzed as we expand throughout our very large health system.