Authors (including presenting author) :
LUI, PSG(1), CHENG THD(2), AU LFV(1), YUEN YHH(2), TANG WSM(3)
Affiliation :
(1)Dietetics Department, Shatin Hospital, (2)Speech Therapy Department, Shatin Hospital, (3) Department of Medicine & Geriatrics, Shatin Hospital
Introduction :
Enteral tube-feeding is commonly required in acute stroke patients- the time required for tube-feeding to be weaned off or total oral feeding to be resumed varies greatly from one patient to another; limiting factors include consciousness level, swallowing ability, appetite, as well as cooperation among the healthcare team. In our current practice, there is no screening tool to identify patients with weaning potentials. Moreover, stroke patients are seen separately by Dietitians and Speech therapists and there is no efficient communication platform for Dietitians and Speech therapists to timely and closely discuss patient’s progress or coordinate interventions together after each review. This leads to a time gap in stepping up of patient’s oral feeding and adjustment of tube-feeding amounts, which can delay the tube-feeding weaning progress.
Objectives :
A pilot study to evaluate the efficiency and efficacy of an enhanced multidisciplinary approach with the use of a real-time messaging platform ‘HA Chat’- in a fast-track feeding tube weaning program for acute stroke patients.
Methodology :
This was a cohort analysis of acute stroke patients admitted to Shatin Hospital for stroke rehabilitation from May 2019 to January 2020. (1) Patients with potential for oral feeding were recruited (RBHOMS score of 4 or 5) (2) More frequent review and training by both Dietitians and Speech therapists (>2 times per week) (3) Patient empowerment (e.g. meal modification to meet personalized food preferences), family engagement (e.g. educate on oral motor exercises and preparation of texture-modified food) during the weaning process to facilitate oral intake (4) Timely inter-professional communication on patient progress was enabled with the use of real-time messaging platform ‘HA Chat’
Result & Outcome :
Mann-Whitney U test was used for statistical analysis. A total of 24 subjects were analyzed (control 13, intervention group 11)- gender and age distributions were similar across both groups. The enhanced multidisciplinary fast-track tube-feeding weaning program successfully and significantly: (1) Decreased the average number of days required to wean off tube feeding from 18.5 to 10.1 days (p< 0.05). (2) Maintained nutritional intake and percentage calorie goals even after tube-feeding was weaned off (control 83.8%, intervention 94.5%, p>0.05). (3) Ensured minimal weight loss during the tube-feeding weaning process (control -0.17%, intervention -0.21%, p>0.05). An enhanced multidisciplinary and personalized enteral tube feeding weaning program should be adopted as part of a fast-track rehabilitation approach for acute stroke patients with higher potential to resume oral feeding. A real-time communication platform such as ‘HA Chat’ can better facilitate interdisciplinary discussions on case progress and minimize time delays in stepping up to oral diet. Faster weaning of tube-feeding enhances patients’ quality of life, minimizes caring stress and reduces length of hospital stay. Further studies should be conducted with larger sample sizes and in collaboration with a wider range of disciplines.
