Improving compliance with early enteral feeding in <24 hours for patients with severe burn injuries: The 'EAT' Project.

Karina Lay¹, Yvonne Singer¹, Dane Holden¹, Kate Lambell¹, Dashiell Gantner¹, Melissa Neely¹, Melinda Pacquola¹, Leah McDonald¹, Marc Schnekenberger¹,
¹Alfred Health, Melbourne, Victoria, Australia

Abstract

Introduction: Early enteral nutrition (EEN) commenced within 24hours of hospitalisation for patients with severe burn injuries has been associated with positive clinical outcomes. In 2022, the Burns Registry of Australia and New Zealand (BRANZ) identified that commencement of EEN at The Alfred Hospital was 59% (n =25/42), below target ≥85%.

Aim: To improve EEN performance at The Alfred Hospital to ≥85% within 12 months.

Methods: Barriers to EEN were identified retrospectively via medical records from January 2020–October 2021. Aggregated case reviews were analysed, and multidisciplinary clinician perspectives were obtained to understand barriers to EEN and identify appropriate strategies. Interventions to improve performance were then conducted including; targeted education, focus groups, infographics, and written communications. ICU and Emergency department guidelines were also modified to advocate for EEN.

Results: Data demonstrated that prior to intervention, the primary factor impacting delivery of EEN was intubation status, with only 30% (n=7/23) of non-intubated patients receiving EEN. Clinician perspectives on the need for nasogastric tube, documentation, and unnecessary fasting were also identified as key barriers. Following intervention strategies, commencement of EEN has increased to 88% overall (n=13/15), within the first 6 months. Specifically, commencement of EEN in non-intubated patients improved to 71% (n=5/7).

Conclusion: The EAT project has demonstrated that a multidisciplinary quality improvement project was successful in facilitating service-wide change increasing the number of patients with severe burns receiving EEN. Furthermore, the project demonstrates that information obtained from data registries play a key role in identifying gaps in patient care and directing service improvement.

Biography

Karina is a clinical dietitian working within the Victorian Adult Burns Service, The Alfred Hospital in Melbourne. Over the past few years, Karina has developed a strong interest in nutrition care for patients with severe burn injuries. She is the principal dietitian for all patients admitted with burns to the Alfred Hospital; across the intensive care unit, inpatient ward, and in the outpatient setting. This specialist clinical area is the focus of both her clinical and emerging research career, with her current research and project work being on adequate and timely nutrition support, metabolic changes, and long-term nutrition challenges.