Complications and emergency department presentations associated with multidisciplinary team management of patients on home enteral nutrition: A systematic literature review

BACKGROUND/AIM: Patients receiving home enteral nutrition (HEN) via enteral feeding tubes may have a high risk of complications. International guidelines recommend multidisciplinary team (MDT) approaches to manage these complex nutrition patients. This review aimed to describe the composition of HEN MDTs and investigate the effect of outpatient MDT care in reducing HEN-related emergency department (ED) presentations and/or complications. METHODS: MEDLINE and CINAHL databases were searched between April 9-17th 2024. Screening, extraction and quality assessment (using the Academy of Nutrition and Dietetics' Evidence Analysis Manual (Quality Criteria Checklist and Cochrane Risk of Bias Tool for Randomised Trials) were conducted independently by two reviewers. RESULTS: Nine studies met the inclusion criteria. Narrative synthesis revealed a largely heterogeneous HEN sample population and considerable differences in HEN-related MDT compositions and service models across countries. Evidence for the role of outpatient MDTs in reducing HEN-related complications and/or ED presentations and hospital admissions in those with enteral feeding tubes was inconsistent. However, available evidence suggested that nurse-led and dietitian-led clinics, particularly when operating under an advanced scope of practice, were associated with reduced complications. CONCLUSIONS: Despite guideline recommendations for MDTs to manage complex nutrition patients, outpatient HEN service models and MDT compositions are heterogeneous. While the classification of HEN-related complications varies, these appear to be common but often manageable in an outpatient setting to avoid ED presentations. Larger, multi-centre studies are needed to clarify the direct impact of outpatient MDT HEN clinics. Future research should also examine how team composition, competencies and service models influence outcomes across diverse clinical practice settings. In the meantime, adherence to current clinical guidelines and lessons from other nutrition-related MDT clinics may optimise HEN management.