Implementation of a Dietitian-Led Enteral Nutrition Support Clinic Results in Quality Improvement, Reduced Readmissions, and Cost Savings

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. Conclusion: 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.