Analysis of Clinical Trends in Dysphagia Management for Patients with Feeding Tube Placement Prior to LTACH Admission: A Retrospective Review

Research Objectives: To assess clinical trends in dysphagia management for patients requiring feeding tube placement prior to long-term acute care hospital (LTACH) admission.

Design: Retrospective review.

Setting: Gaylord Hospital, a 137-bed LTACH located in Wallingford, Connecticut, USA.

Participants: Patients admitted to Gaylord Hospital between 4/1/2021, and 12/31/2022, with a nil per os (NPO) diet order and a percutaneous endoscopic gastronomy (PEG) tube which was placed at the discharging short-term acute care hospital (STACH) prior to LTACH admission.

Interventions: N/A.

Main Outcome Measures: Length of time in days between: STACH admission and PEG placement, PEG placement and LTACH admission, LTACH admission and LTACH instrumental evaluation, LTACH admission to partial PO, partial PO to full PO, PEG placement to partial PO, and PEG placement to full PO.

Results: 4,628 patient records were generated via electronic medal record report, with 175 meeting the inclusion criteria for analysis. Upon LTACH admission, 154/175 (88%) of patients were transitioned to a partial PO diet, and 105/175 (60%) were transitioned to a full PO diet. Altogether, patients transitioned to a partial PO diet after a median of eight days. Patients enrolled in the brain injury program took the longest to transition to a full PO diet following PEG placement (median of 40 days); in contrast, patients enrolled in the medical general program transitioned to full PO after a median of 25.5 days. Patients admitted with ventilatory support had a PEG for the longest duration prior to LTACH admission (median 22 days), while patients in the stroke program had a PEG for the shortest duration (median of 5 days).

Conclusions: This evidence suggests more critical thinking is needed at the STACH level of care to determine clinical appropriateness of PEG tube placement. The brief time period in which some patient populations, specifically those with stroke, transitioned from NPO to PO once admitted to the LTACH setting presents a potential argument for maintaining patients on less invasive and impactful means of nutrition prior to LTACH transfer.

Author(s) Disclosures: None