Journal Article

Evaluating multifaceted strategies to prevent nasoenteral tube complications and achieve significant cost savings in critically ill patients: the ENHANCE-CRIT trial

Brandi, Simone, de Paula Nogueira, Priscila Barsanti, Malheiro, Daniel Tavares, Silva, João Manoel, Pedroso, Aline Cristina, Toledo, Diogo Oliveira, Ribeiro, Fernanda Antunes, Sodré da Costa, Lidiane Soares, Laselva, Claudia Regina

2025

Overview

BackgroundNasoenteral 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.ObjectiveThis study aimed to reduce complications related to the placement and maintenance of NETs in critically ill patients using multifaceted strategies.MethodsWe 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.ResultsAfter 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.ConclusionThe 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.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adult / Aged / Clinical decision making / Clinical outcomes / Cohort Studies / Cost control / Cost Savings - methods / Cost Savings - statistics & numerical data / COST-EFFECTIVENESS / Critical care / Critical Illness - economics / Critical Illness - therapy / Decision support systems / Decision support, clinical / Efficiency, Organisational / Electronic health records / Evidence-based nursing / Female / Health care expenditures / Hospitals / Humans / Intervention / Intubation, Gastrointestinal - adverse effects / Intubation, Gastrointestinal - economics / Intubation, Gastrointestinal - methods / Length of Stay - statistics & numerical data / Male / Medical records / Middle Aged / Morbidity / Nurses / Original research / Patient safety