Ribeiro Fernanda Antunes, Sodré da Costa Lidiane Soares, Pedroso Aline Cristina, de Paula Nogueira Priscila Barsanti, Brandi Simone, Toledo Diogo Oliveira, Laselva Claudia Regina, Malheiro Daniel Tavares, Silva João Manoel
Enteral and Parenteral Nutrition Team, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
BMJ Open Qual. 2025 Mar 12;14(1):e003177. doi: 10.1136/bmjoq-2024-003177.
Nasoenteral tube (NET) use is common in critically ill patients but is associated with significant complications, including accidental dislodgement, malpositioning in the bronchial tree or mechanical failures, which can impede nutritional therapy. These complications often lead to adverse events that increase hospital stay, costs, and patient morbidity.
This study aimed to reduce complications related to the placement and maintenance of NETs in critically ill patients using multifaceted strategies.
We conducted an observational cohort study between February 2022 and March 2023 using the Institute for Healthcare Improvement's (IHI) Model for Improvement. Data were collected from electronic forms, and process indicators were analysed for adequacy of tube fixation and complication rates. The study compared preintervention data to outcomes following five strategies: nasal bridle fixation, staff training, integration of a decision-support tool, restructuring of the NET care plan and practical simulation-based training.
After implementing the interventions, complications related to NET decreased from 41% to 28%, preventing 200 adverse events. This reduction led to an improvement in patient outcomes, including a shorter hospital stay by 10 days on average, freeing up a total of 6520 bed days. The intervention not only reduced complications but also optimised hospital resource utilisation. An economic analysis revealed total savings of US$95 208, demonstrating both clinical efficacy and financial benefits.
The multifaceted strategies significantly reduced NET-related complications, improved patient outcomes, and enhanced resource efficiency in critical care settings. These interventions demonstrated substantial cost-effectiveness, underscoring the value of structured, preventive measures in improving patient safety and reducing healthcare costs.
鼻肠管（NET）在重症患者中使用很常见，但会引发严重并发症，包括意外移位、在支气管树中位置不当或机械故障，这些都会妨碍营养治疗。这些并发症常常导致不良事件，增加住院时间、费用和患者发病率。
本研究旨在通过多方面策略减少重症患者鼻肠管放置和维护相关的并发症。
我们在2022年2月至2023年3月期间使用医疗改进研究所（IHI）的改进模型进行了一项观察性队列研究。数据从电子表格中收集，并分析过程指标以评估管道固定的充分性和并发症发生率。该研究将干预前数据与以下五种策略后的结果进行了比较：鼻系带固定、工作人员培训、决策支持工具的整合、鼻肠管护理计划的重组以及基于实践模拟的培训。
实施干预措施后，与鼻肠管相关的并发症从41%降至28%，预防了200起不良事件。这种减少带来了患者预后的改善，包括平均住院时间缩短10天，总共腾出6520个床位日。该干预措施不仅减少了并发症，还优化了医院资源利用。一项经济分析显示总共节省了95208美元，证明了临床疗效和经济效益。
多方面策略显著降低了与鼻肠管相关的并发症，改善了患者预后，并提高了重症监护环境中的资源效率。这些干预措施显示出显著的成本效益，凸显了结构化预防措施在提高患者安全和降低医疗成本方面的价值。
