Introduction: Initiation of tube feeding (TF) via gastrostomy tube (G-tube) after insertion in dysphagic stroke patients is often delayed per physician preference with delayed feeding (DF) initiated at 12-24 hours being a common practice. Guidelines suggest that initiation of G-tube feeding (EF) within 4 hours after insertion is safe and does not lead to more complications. The stroke and interventional radiology (IR) physicians at a comprehensive stroke center agreed to an EF guideline in April 2016 and changed the post-insertion G-tube feed initiation time in all stroke patients from 24 hours to 6 hours. A year after, we conducted this retrospective study to understand the impact of EF guideline on TF timings.
Methods: All stroke patients that had G-tubes placed by IR between April 2015 and April 2017 were eligible for inclusion in the study. Patients with non-stroke diagnoses were excluded, as were those whose tube feeds were never initiated. In addition to TF timings, data regarding complications and reasons for guideline deviation were recorded. Descriptive analyses were done for continuous and categorical variables.
Results: Compared to pre-protocol patients (n= 37), the TF initiation time in EF group (n= 47, range 5-51 hours) decreased by 11.5 hours after institution of EF guidelines (25.8 hrs vs 14.2 hrs, p < 0.0001). Only eight patients (17%) had TFs started by 6 hours, while twenty-one (44%) had TF started by 10 hours. There was a nonsignificant increase in complications after protocol initiation: 8 patients (17%) in the protocol group vs 4 (11%) in the pre-protocol group (OR = 1.69, 0.47 - 6.13, 95% CI). In five of eight patients in the protocol group who developed complications, TFs were initiated after 12 hours. No death was noted on account of EF. No significant difference in length of stay was noted. Delays in TF initiation were mostly due to failure to write appropriate orders (n=8) and less often for worsening in clinical status due to insertion related (n=2) or unrelated (n=2) complications.
Conclusions: TF initiation time can be significantly improved with institution of an EF guideline without any significant increase in complications. With education, guideline compliance can be improved further.