May 2024 CME Activity #2: Establishing a Clinical Care Pathway to Expedite Rehabilitation Transitions for Stroke Patients With Dysphagia and Enteral Feeding Needs-Establishing a Clinical Care Pathway to Expedite Rehabilitation Transitions for Stroke Patients With Dysphagia and Enteral Feeding Needs

Establishing a Clinical Care Pathway to Expedite Rehabilitation Transitions for Stroke Patients With Dysphagia and Enteral Feeding Needs

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The study investigates the safety and efficacy of a physiatrist-led clinical care pathway to expedite rehabilitation transitions for stroke patients with dysphagia who require nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG) feeding. This retrospective single-center observational study involved 426 adults with stroke and dysphagia admitted to an acute hospital. PM&R evaluated these patients for rehabilitation admission with either NGT or PEG.<br /><br />Key findings revealed that 86.3% of patients with NGT recovered to a total oral diet during their rehabilitation stay, compared to 38.6% with PEG. Those with NGT achieved total oral diets significantly faster (20.37 days) compared to those with PEG (34.46 days). Additionally, the acute hospital length of stay was shorter for NGT patients (12.9 days) versus PEG patients (20.4 days), while the rehabilitation length of stay did not differ significantly between the groups.<br /><br />Based on these results, the physiatrist-led program demonstrated the ability to improve practices by reducing unnecessary PEG placements and shortening acute hospital stays. This approach aligns better with existing guidelines, which recommend NGT as the preferred initial feeding route post-stroke. By doing so, the program helped prevent multiple unnecessary invasive surgical procedures and facilitated smoother transitions to rehabilitation.<br /><br />The study highlights the importance of PM&R consultation for evaluating dysphagia prognosis and facilitating efficient care transitions. Though limitations include its single-center design and potential observer bias, the findings underscore the potential benefits and necessity for broader implementation of similar clinical pathways in managing stroke patients with dysphagia.<br /><br />Moreover, the study suggests that leveraging interdisciplinary approaches and aligning practice patterns with guidelines can significantly impact patient outcomes and resource utilization across healthcare settings. Future research should focus on broader, multi-center studies, prospective data collection, and evaluation of cost-effectiveness to further validate these findings.

Keywords

stroke

dysphagia

rehabilitation

nasogastric tube

percutaneous endoscopic gastrostomy

physiatrist-led care

acute hospital stay

oral diet recovery

PM&R consultation

clinical care pathway