OTU-27 The hidden burden of emergency department attendances for late enteral tube feeding complications

Introduction Late complications related to enteral tube feeding are little documented in the literature. One 10 year study reports a longitudinal rate of displacement of up to 12%1. Here we investigate the hidden burden of community enteral tube feeding on the Emergency Department (ED). Method We undertook a retrospective review of attendances to the emergency department of the district general hospital in Wolverhampton with gastrostomy and jejunostomy tube complications. ED discharge coding was reviewed over an 18 month period to identify patients attending ED with a gastrostomy or jejunostomy tube. Electronic medical records were then reviewed to determine if the primary reason for attendance was related to the enteral feeding tube. Results In an 18 month period 139 attendances were recorded, 56% of cases were male patients. Fifty patients came from nursing homes, 8 from residential homes, 2 from another hospital and 79 (57%) from their own homes. One hundred and nine were completely dependent on the enteral tube for all nutrition and hydration, 8 required it for fluids only, 2 for nutrition only and 20 were not completely dependent on the enteral tube. The type of tube prompting attendance is shown in table 1 (PEG = percutaneous endoscopic gastrostomy, RIG= radiologically inserted gastrostomy, J= jejunostomy, BGT = balloon gastrostomy tube) The problems causing the ED attendance are shown in table 2. Where in hours was defined as 9–5 Monday to Friday and all other times were defined as out of hours 57 attending during standard working hours of the nutrition support team and 82 attended when the support team were not available, out of hours. Conclusion Using current tariffs the cost of the attendances to ED are £29,000 over the analysed period, with a significant proportion of patients coming from their own home and 60% out of hours. More work on education and supporting carers to resolve problems themselves could reduce the burden on busy EDs.