Introduction PEG insertion is a common method to maintain nutrition and hydration in patients with swallowing difficulties. Although traditionally an in-patient procedure, there has been a move over the last decade towards day-case provision in some centres. Unfortunately however there are limited data regarding the optimal day-case service and only 2 small publications relating to day-case PEG insertion over the past 10 years. We developed a Nurse-led day-case service and undertook a prospective audit to compare with standard in-patient placement.
Method A day-case pathway, guidelines, discharge and follow up process was developed for patients with Head and Neck cancer at UHCW. The Nutrition Nurse Specialist was responsible for all aspects of the day-case PEG procedure. This included: initial assessment; co-ordination with endoscopy for insertion date; percutaneous puncture and PEG placement in all patients alongside an Endoscopist; review of patients post procedure and discharge; follow up after 24 h. Data was collected prospectively for the first 50 nurse led day-case PEGs, and compared retrospectively with the previous 50 consecutive in-patient PEG placements for head and neck cancer.
Results There was no difference in complication rates between the 2 groups. There were no major complications in either group. Minor complications were equivalent in both groups and related to easily treatable stoma site infections. There was no significant difference in the timeliness of PEG insertion in day-case vs in-patient insertion (54% pre-treatment versus 50%). The in-patient PEG cohort collectively utilised a total of 150 bed days whereas the day-case PEGs were all safely discharged on the day of PEG procedure by the Nutrition Nurse Specialist. Two of the day-case patients were re-admitted on the evening after the procedure due to social reasons. All day-case PEGs were followed up by the Nutrition nurse the day after PEG insertion. By comparison only 20% of the patients in the in-patient group were reviewed with 24 h of their procedure.
Conclusion A Nurse led day-case PEG service is both safe and effective in the head and neck cancer population as long as there is a standardised protocol in place. It allows more efficient use of resources, saving hospital bed days, freeing up medical capacity for other in-patients, and ensuring robust follow-up and review post insertion. A larger scale multi-centre evaluation of day-case PEG services is required to facilitate development of a Gold standard pathway for day-case PEG service delivery.
Disclosure of interest None Declared.