Introduction

The Percutaneous Endoscopic Gastrostomy (PEG) tube is used to provide enteral nutrition when oral intake is not adequate.
Regular follow-up of PEG patients is essential to detect complications and clarify doubts. A partnership protocol was developed with ACES Lisboa Central (ACESLC) and Loures/Odivelas (ACESLO) to improve continuity of care.

Results & Findings

We analyzed data from PEG patients followed between 2023 and 2024. Inclusion criteria for referral to ACES included:
• Clinical stabilization;
• Absence of PEG-related complications requiring hospital admission;
• Willingness and ability of the patient/caregiver to participate actively in care.
Monitoring of the protocol was based on quarterly evaluation of five performance indicators:
1st: Percentage of patients referred to ACES, out of the total seen in PEG review consultations;
2nd: Percentage of referred patients who returned to hospital before the expected date due to complications;
3rd: Percentage of cases in which complete referral documentation, as per protocol, was sent to ACES;
4th: Percentage of cases with confirmation that ACES sent back all required clinical data;
5th: Percentage of compliance with scheduled PEG follow-up appointments at ACESLO.

Summary & Discussion

The 1st indicator shows low referral rates in both years, mainly due to out-of-area institutionalization, clinical worsening, or death.
The 2nd indicator indicates fewer unplanned hospital readmissions among referred patients; when they occurred, complications were the cause.
Results show fewer complications and emergency visits, reflecting the benefit of close ACES collaboration.
The 3rd indicator reflects 100% compliance in sending referral documentation.
The 4th indicator showed gaps in home visit records in 2023, improved in 2024 through better coordination.
One challenge was the mismatch between designated ACES nurses and those conducting home visits, which required articulation with family health teams (USF).
The 5th indicator confirms overall adherence to scheduled PEG reviews.

Conclusion

The protocol streamlined follow-up for PEG patients.
In 2024, a previous limitation was overcome, allowing referrals of institutionalized patients within the protocol’s coverage.
As a pioneering project, we aim to share these findings to support protocol expansion to other units.

References

Kurion, M., Andrews, R., Tattersall, R., McAlindon, M., Wong, E., Johnston, A., Hoeroldt, B., Dear, K. & Sanders, D. (2017). Gastrostomies preserve but do not increase quality of life for patients and caregivers. Clinical Gastroenterology and Hepatology. 15, 1047-1054.
Lee, C.,Kang, H., Lim, Y., Lee, J., Koh, M., Lee, J., Yang, C. & Kim, J. (2013). Comparison of complications between endoscopic and percutaneous replacement of percutaneous endoscopic gastrostomy tubes. JKoren Medical Sciences. 28, 1781-1787.
Lucendo, A. J. & Friginal-Ruiz, A. B. (2014). Percutaneous endoscopic gastrostomy: An update on its indications, management, complications, and care. Revista Española de Enfermedades Digestivas. 106(8), 529-539.