EP 601 TUBE-SBO: Timely Use and Benchmarking of Enteral decompression in Small Bowel Obstruction
Ross Nieuwoudt, Robert Young, Raimundas Lunevicius, Nikhil MisraAbstract
Aims
Upper gastrointestinal tract decompression by nasogastric tube (NGT) is standard practice when managing small bowel obstruction (SBO) to prevent aspiration and its complications, but a recent Prevention of Future Deaths report has raised concerns about delays in NGT placement. A retrospective audit of NGT placement was performed in a metropolitan University teaching hospital to assess adherence to national guidance and safety standards.
Methods
Twenty-one emergency presentations with small bowel obstruction were randomly identified between January and April 2025. Data were extracted from hospital electronic patient record systems. NGT insertion, time from diagnosis to insertion, documentation quality, and documentation of patient refusal were used to evaluate NGT placement practice.
Results
Thirteen male and twelve female patients were included in this study. An NGT was inserted in 15 (71%) patients. The median time from diagnosis to NGT insertion was 8.4 hours (IQR: 5.7–10.4). No records of NGT insertion were found in four (19%) case notes, of whom two (9.5%) underwent emergency laparotomy. Of the 15 NGTs placed, only 8 (53%) were documented. In both patients who declined NGT placement the risks of this were not documented.
Conclusions
This audit identified heterogeneity in management and inconsistency in documentation for SBO with NGTs, potentially exposing patients and clinicians to avoidable risks. The findings were presented at a departmental audit meeting, prompting urgent intervention: a hospital-wide Standard Operating Procedure was published, assigning responsibility for NGT insertion within two-hours to the diagnosing clinician. This was supported by a multidisciplinary education program.