Abstract Body: Background: Dysphagia is a common complication of stroke and often leads to the need for modified diets and alternate feeding routes. Length of stay (LOS) for stroke patients requiring percutaneous endoscopic gastrostomy (PEG) tubes is often longer than those who can eat by mouth. The decision to place a PEG is multifactorial and multidisciplinary, involving speech-language pathologist (SLP), dietary, and neurology input, as well as goals of care. Despite this complex decision-making process, there are few existing algorithms to guide the need and timing for PEG placement.
Hypothesis: Use of a PEG algorithm will result in timelier PEG placement and shorter LOS for acute stroke patients requiring artificial nutrition.
Methods: A multidisciplinary team, including physicians, nurses, registered dieticians, and SLPs designed an evidenced based algorithm to guide PEG placement. Based on assessment and individual patient factors, possible algorithm pathways included dysphagia treatment and/or calorie count by nursing and dieticians to guide decision-making for PEG placement.
A retrospective study was conducted in the inpatient setting of a comprehensive stroke center. Data included 68 acute ischemic and hemorrhagic stroke patients admitted to the Neurology and Neurosurgery services from 1/1/2023-2/29/24. Only those patients who were identified as being at risk for significant oropharyngeal dysphagia, aspiration pneumonia, and/or malnutrition were included in the study. Data collected included age, diet recommendation, and initial National Institutes of Health Stroke Scale Score with a focus on length of time from PEG recommendation to PEG placement and LOS. Statistical analysis was completed via t-test.
Results:Comparing algorithm (n=30) and non-algorithm (n=38) groups, there was an average decrease of 3.86 days from PEG recommendation to placement in the algorithm group. Although this was not statistically significant (p=0.211), this resulted in decreased LOS from 24.2 to 20.0 days and hospital savings of ~ $7,720 per patient.
Conclusions: Implementation of a multidisciplinary PEG algorithm resulted in reduced time from PEG recommendation to placement and shorter LOS. This novel process helped to guide decision-making for timelier PEG placement. Ongoing studies will be powered to assess overall impact on LOS, costs, outcomes, and complications.