EP588 - Review of the need for Immediate Nasogastric Tube Insertion in patients with Small Bowel Obstruction: Single Centre Quality Improvement Project

Abstract Aim This QIP was conducted in a busy UK hospital. It aims to review, improve, and stress the importance of early insertion of an NG tube in patients who have clinically suspected or radiologically confirmed small bowel obstruction. Method Retrospective data collection involving 72 patients, in a period from Jan to April 2023 (50 patients) and from May to July 2023 (22 patients)Inclusion criteria: adult patients with SBO (clinically suspected or radiologically confirmed) and NGT insertion advised by the surgical teamExclusion criteria: paediatric patients, LBO, and patients not advised NGT in ED Results In the first cycle, we found that NG insertion is delayed 84% > 7 hrs. With associated morbidity of pneumonia, including aspiration in 20% of patients, ileus and sepsis in 8%, and re-admission and mortality in 6%, respectively. The following interventions were carried out. Broad communication with the ED team to highlight the importance of NG insertion for suspected patients. Provide NGT training for ED nursing staff The surgical team and admission nurses should inquire about NGT insertion before accepting patients' admission to surgical emergency wards. Circulating the QIPS recommendation Trust-wide as sharing learning point Post-intervention, we noticed a 50% delay in NGT insertion, which is a huge improvement compared to the 84% delay Conclusion Early insertion of NG for decompression in both pre and post-op periods is known to decrease associated complications, including bowel oedema, perforation, aspiration pneumonia, and post-ileus, leading to better outcomes and a significant decrease in hospital stay length.