Reducing 30-day post gastrostomy insertion mortality with a feeding issues multidisciplinary team meeting

Area of Science:

• Gastroenterology
• Clinical Quality Improvement
• Medical Ethics

Background:

• Percutaneous endoscopic gastrostomy (PEG) insertion decision-making involves complex medical and ethical considerations.
• Thirty-day mortality post-PEG insertion is a key quality indicator for endoscopy services and the 'Getting It Right First Time' (GIRFT) program.
• Evaluating new clinical pathways and scoring systems is crucial for optimizing patient outcomes.

Purpose of the Study:

• To assess the impact of a newly adopted Feeding Issues Multidisciplinary Team (FIMDT) on 30-day mortality after PEG insertion.
• To evaluate the clinical utility of the Royal Free Gastrostomy Score (RFGS) in guiding PEG insertion decisions.
• To improve the quality of care and patient selection for PEG procedures.

Main Methods:

• Retrospective observational study design.
• Data collected over a 4-year period (January 2016 - December 2019) as part of a quality improvement project.
• Statistical analysis and quality improvement methodologies were employed to interpret data on PEG insertions, mortality rates, and RFGS application.

Main Results:

• Following FIMDT adoption, 30-day post-PEG mortality decreased significantly from 10.64% to 6.6% (p=0.04).
• The mean interval between 30-day mortality events increased substantially post-FIMDT implementation.
• The Royal Free Gastrostomy Score (RFGS) was significantly higher in patients declined for PEG insertion and in those who died within 30 days post-procedure, indicating its utility in risk stratification.

Conclusions:

• The implementation of a Feeding Issues Multidisciplinary Team (FIMDT) demonstrably reduced 30-day mortality associated with percutaneous endoscopic gastrostomy (PEG) insertion.
• The Royal Free Gastrostomy Score (RFGS) is a valuable tool for assessing mortality risk and informing patient selection for PEG procedures.
• These findings support the integration of multidisciplinary team approaches and validated scoring systems to enhance patient safety and care quality in PEG insertion.