Document Detail


Effect of physician education and patient counseling on inpatient nonsurgical percutaneous feeding tube placement rate, indications, and outcome.
MedLine Citation:
PMID:  20065910     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The decision to place a percutaneous feeding tube (PFT) in patients who are at the end of life is multidimensional and often complicated. We assessed the effect of physician education and counseling for patients and their surrogates on inpatient nonsurgical (endoscopic and radiologic) PFT placement rates, indications, complications, and mortality. METHODS: In a pre-paid group practice, a geriatrician initiated a program of physician education and patient/surrogate counseling on the ethical and nutritional aspects of long-term enteral feeding. We compared rates of nonsurgical PFT placement (excluding those for cancer therapy or gastric decompression), indications, complications, and short- and long-term mortality in adult inpatients before (2004) and after (2005) the program. RESULTS: In 2004 and 2005, 115 and 60 inpatients underwent PFT placement, respectively. The annual number of hospital admissions was similar, but the rate of PFT placement declined (0.80% vs. 0.44%, P < 0.0001). The indications were cerebrovascular accident (42 [37%] versus 22 [37%]), dementia (15 [13%] versus 3 [5%]), other neurological disease (28 [24%] versus 16 [26%]), and miscellaneous disease (30 [26%] versus 19 [32%]); P > 0.05. Severe infectious complications occurred in 4 (3%) versus 0 (0%) patients, P > 0.05. Mortality (2004 versus 2005) at 30 days (23 [20%] versus 11 [18%]), 1 year (62 [54%] versus 29 [48%]) and 2 years (72 [63%] versus 31 [52%]) was similar, P > 0.05. CONCLUSION: A pilot program of educating referring physicians and counseling patients and their surrogates reduced the rate of inpatient PFT placement by nearly 50%. Indications, severe complications and short- and long-term mortality remained unchanged.
Authors:
Arun Swaminath; George F Longstreth; Eva M Runnman; Su-Jau Yang
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Southern medical journal     Volume:  103     ISSN:  1541-8243     ISO Abbreviation:  South. Med. J.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-08     Completed Date:  2010-03-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0404522     Medline TA:  South Med J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  126-30     Citation Subset:  AIM; IM    
Affiliation:
Division of Gastroenterology, Columbia University Presbyterian Hospital, New York City, NY 10032, USA. as3576@columbia.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Counseling*
Education, Medical, Continuing*
Enteral Nutrition / mortality,  utilization*
Family
Female
Humans
Male
Pilot Projects
Terminal Care
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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