Reducing Hospital Visits for Patients with Jejunostomy Tubes

Jejunostomy tubes are a form of enteral nutrition used in patients following a diagnosis of oesophageal or gastric cancer. Nutritional optimisation is important in the recovery of this group of patients. While beneficial, enteral nutrition can be a source of complications and increased burden of care, leading to unplanned hospital attendance. This Quality Improvement project plan’s key focus was to find a solution to reduce the number of hospital visits in patients with jejunostomy tubes. This was achieved by using the DMAIC framework as a guide through each stage of the project plan and using a selection of QI tools such as a stakeholder analysis, driver diagram and process flow maps. The data collected identified the most common tube complication which contributed to hospital visits; Dislodgement (15%), Suture Issue (13%), blockage (6%) and rarely small bowel obstruction (1.4%). The number of unplanned visits secondary to tube complications ( 31 visits in 16 patients) were collected and factors contributing to tube morbidity was analysed. The emergency department process was investigated, and it was discovered that there was no clear pathway for ED staff to follow when they encounter patients with J-tubes. This prompted the decision to create a new emergency department pathway, to standardise the management of patients with enteral feeding tubes. It is hoped that by implementing this pathway that the emergency department staff will have a clear definitive management for patients with J-tubes, thereby reducing these patients’ hospital visits.