A cost utility analysis of the clinical algorithm for nasogastric tube placement confirmation in adult hospital patients

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Abstract

AIM:
The aim of this study was to evaluate the effectiveness of pH paper testing of aspirate and chest x-ray for determining nasogastric tube (NGT) placement in terms of cost and patient outcome.
BACKGROUND:
Nasogastric tubes are frequently used in clinical practice, however during insertion the practitioner is blinded as to the precise final location. Despite robust checking procedures, recognized patient morbidity and mortality associated with this procedure have resulted in national safety alerts prompting the revision of all NGT care clinical guidelines.
DESIGN:
Cost utility analysis using economic modelling.
METHODS:
A decision tree was built and populated with effectiveness data gathered from a systematic search of the extant literature. Specificity, pooled sensitivity and event probabilities were calculated using statistical software. Patient outcome was measured in terms of quality of life. Health state utilities were gathered from a sample (n = 23) of adult surgical patients using a recognized instrument. Cost data were gathered using published sources. The study adopted a third party payer perspective in a Scottish context and was completed in June 2013.
RESULTS:
The results confirm that the current UK algorithm advocated by the National Patient Safety Agency appears to offer the most cost effective approach to NGT confirmation in terms of cost and patient outcome. Sensitivity analyses indicate that these findings may be significantly altered by tube aspiration success and the rates of chest x-ray interpretation errors.
CONCLUSION:
The results confirm current UK recommendations and have wider policy implications for those areas, whereby chest x-ray is recommended as the first and only acceptable confirmation approach.
Original languageEnglish
Pages (from-to)201-216
Number of pages16
JournalJournal of Advanced Nursing
Volume73
Issue number1
Early online date21 Sep 2016
DOIs
Publication statusPublished - Jan 2017

Fingerprint

Cost-Benefit Analysis
Costs and Cost Analysis
Thorax
X-Rays
Health Insurance Reimbursement
Decision Trees
Patient Safety
Software
Economics
Quality of Life
Guidelines
Morbidity
Safety
Sensitivity and Specificity
Mortality
Health

Keywords

  • algorithm
  • nasogastric tube placement
  • hospital patients

Cite this

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title = "A cost utility analysis of the clinical algorithm for nasogastric tube placement confirmation in adult hospital patients",
abstract = "AIM:The aim of this study was to evaluate the effectiveness of pH paper testing of aspirate and chest x-ray for determining nasogastric tube (NGT) placement in terms of cost and patient outcome.BACKGROUND:Nasogastric tubes are frequently used in clinical practice, however during insertion the practitioner is blinded as to the precise final location. Despite robust checking procedures, recognized patient morbidity and mortality associated with this procedure have resulted in national safety alerts prompting the revision of all NGT care clinical guidelines.DESIGN:Cost utility analysis using economic modelling.METHODS:A decision tree was built and populated with effectiveness data gathered from a systematic search of the extant literature. Specificity, pooled sensitivity and event probabilities were calculated using statistical software. Patient outcome was measured in terms of quality of life. Health state utilities were gathered from a sample (n = 23) of adult surgical patients using a recognized instrument. Cost data were gathered using published sources. The study adopted a third party payer perspective in a Scottish context and was completed in June 2013.RESULTS:The results confirm that the current UK algorithm advocated by the National Patient Safety Agency appears to offer the most cost effective approach to NGT confirmation in terms of cost and patient outcome. Sensitivity analyses indicate that these findings may be significantly altered by tube aspiration success and the rates of chest x-ray interpretation errors.CONCLUSION:The results confirm current UK recommendations and have wider policy implications for those areas, whereby chest x-ray is recommended as the first and only acceptable confirmation approach.",
keywords = "algorithm, nasogastric tube placement , hospital patients",
author = "Agi McFarland",
note = "found from WoS File provided (attached); requested different version 9-2-17 and 27-3-17 Library applied exception and email in SAN; author did not have an account in PURE until January 2017. ET 13-4-17 ^Exception status: author email in SAN; agreed no exception can be applied (library exception review, October 2018)",
year = "2017",
month = "1",
doi = "10.1111/jan.13103",
language = "English",
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pages = "201--216",
journal = "Journal of Advanced Nursing",
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PY - 2017/1

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N2 - AIM:The aim of this study was to evaluate the effectiveness of pH paper testing of aspirate and chest x-ray for determining nasogastric tube (NGT) placement in terms of cost and patient outcome.BACKGROUND:Nasogastric tubes are frequently used in clinical practice, however during insertion the practitioner is blinded as to the precise final location. Despite robust checking procedures, recognized patient morbidity and mortality associated with this procedure have resulted in national safety alerts prompting the revision of all NGT care clinical guidelines.DESIGN:Cost utility analysis using economic modelling.METHODS:A decision tree was built and populated with effectiveness data gathered from a systematic search of the extant literature. Specificity, pooled sensitivity and event probabilities were calculated using statistical software. Patient outcome was measured in terms of quality of life. Health state utilities were gathered from a sample (n = 23) of adult surgical patients using a recognized instrument. Cost data were gathered using published sources. The study adopted a third party payer perspective in a Scottish context and was completed in June 2013.RESULTS:The results confirm that the current UK algorithm advocated by the National Patient Safety Agency appears to offer the most cost effective approach to NGT confirmation in terms of cost and patient outcome. Sensitivity analyses indicate that these findings may be significantly altered by tube aspiration success and the rates of chest x-ray interpretation errors.CONCLUSION:The results confirm current UK recommendations and have wider policy implications for those areas, whereby chest x-ray is recommended as the first and only acceptable confirmation approach.

AB - AIM:The aim of this study was to evaluate the effectiveness of pH paper testing of aspirate and chest x-ray for determining nasogastric tube (NGT) placement in terms of cost and patient outcome.BACKGROUND:Nasogastric tubes are frequently used in clinical practice, however during insertion the practitioner is blinded as to the precise final location. Despite robust checking procedures, recognized patient morbidity and mortality associated with this procedure have resulted in national safety alerts prompting the revision of all NGT care clinical guidelines.DESIGN:Cost utility analysis using economic modelling.METHODS:A decision tree was built and populated with effectiveness data gathered from a systematic search of the extant literature. Specificity, pooled sensitivity and event probabilities were calculated using statistical software. Patient outcome was measured in terms of quality of life. Health state utilities were gathered from a sample (n = 23) of adult surgical patients using a recognized instrument. Cost data were gathered using published sources. The study adopted a third party payer perspective in a Scottish context and was completed in June 2013.RESULTS:The results confirm that the current UK algorithm advocated by the National Patient Safety Agency appears to offer the most cost effective approach to NGT confirmation in terms of cost and patient outcome. Sensitivity analyses indicate that these findings may be significantly altered by tube aspiration success and the rates of chest x-ray interpretation errors.CONCLUSION:The results confirm current UK recommendations and have wider policy implications for those areas, whereby chest x-ray is recommended as the first and only acceptable confirmation approach.

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