In late 2010, the palliative-care team at Novant Health Forsyth Medical Center in Winston-Salem, N.C., wanted to find out whether hospital staff were complying with new evidence-based guidelines recommending against the use of feeding tubes in patients with advanced dementia. They found large variations in insertion rates for percutaneous endoscopic gastrostomy (PEG) tubes, depending on the type of attending physician.
When patients at skilled-nursing facilities experienced health problems that made them unable to swallow and they were admitted to the hospital, hospitalists cared for them.
“Hospitalists were requesting over 90% of the permanent feeding tubes,” said Dr. Charles Stinson, clinical director of palliative-care services. “It was an 'aha!' moment for us.” A small percentage of tubes were requested by neurologists and there were rare requests by other specialists.