An evaluation of current home enteral nutrition services at principal referral hospitals in New South Wales, Australia

Abstract

Objective This cross-sectional study investigates the home enteral nutrition (HEN) services of public principal referral hospitals in NSW, Australia, comparing their services to best practice guidelines for HEN. Methods HEN service processes were investigated using an online questionnaire and telephone interview with the dietitian primarily working with HEN at each hospital. Results Participating hospitals reported a total of approximately 3200 HEN patients, 76% required oral nutrition support. Only 69% of hospitals had a dietitian allocated to their HEN service and no hospitals had established multidisciplinary teams to manage HEN patients. Post-discharge follow-up, as recommended for tube fed and oral patients, was achieved by 8% and 15% of hospitals respectively. Forty-six per cent of dietitians were satisfied and 46% of dietitians were dissatisfied with current HEN services provided, and reported the following improvements were required: increased clinical resources allocated to HEN dietitian/coordinator; increased outpatient services (home visits, outpatient clinic, multidisciplinary clinic); and an efficient registration process and database. Conclusions HEN services among participating hospitals are inconsistent, demonstrating gaps in service provision. Baseline assessment scores varied, with an average of 61% of recommendations currently in use. Best practice guidelines are not firmly adhered to due to limited funding and allocated resources for HEN. What is known about the topic? HEN is recognised as a cost-effective and reliable way of treating patients requiring nutrition support post hospital discharge. There are best practice guidelines available to ensure quality care is provided to HEN patients in the community or home setting. As there is no national framework in place for HEN in Australia, currently total patient numbers are unknown and each state and territory provides different levels of service delivery and funding for HEN. It is unknown how guidelines in Australia have been implemented and practiced, as no studies were found that have audited HEN services in Australia. What does this paper add? From the participating hospitals we were able to obtain updated data on HEN patient numbers (~3200). This paper reports on baseline scores in meeting best practice HEN guidelines for tertiary referral hospitals in NSW, Australia and identifies gaps in service provision. It is essential to identify reasons that limit adherence to HEN guidelines, as consequences may include unnecessary re-admissions to emergency departments or hospitals, increasing healthcare costs. Our study found notable differences in service provision ranging from 29% to 86% of recommendations of HEN guidelines achieved, and identified a lack of multidisciplinary teams to manage HEN patients. What are the implications for practitioners? We found HEN services among principal referral hospitals are inconsistent and best practice guidelines are currently not adhered to. National guidelines together with local health policies assist in defining the required standard of care, enhance service delivery and promote clinical excellence. We found the NSW Health Agency for Clinical Innovation HEN Implementation Checklist to be a practical tool for obtaining baseline scores for adherence to best practice guidelines. Regulation of HEN will be positive for HEN users by ensuring a more equitable service is available by introducing consistent funding for HEN nationally. However, it is the responsibility of states and local health districts to implement guidelines, contributing to better health and quality of care provided to patients.