Background Due to the complex nature of neurosurgical patients, nasogastric (NG) tube feeding is often implemented to provide nutrition for patients unable to consume adequate oral intake. During recovery patients on enteral nutrition (EN) are progressed to oral nutrition (ON), which can quickly result in NG removal and discontinuation of an existing feeding plan. This is often before patients become established on sufficient oral intake to meet their nutritional requirements.

Methods We conducted a 3-month, prospective audit on 5 neurosurgical wards to answer 6 key questions related to commencement of ON and removal of NG tubes: (1) How long is average response time from initial speech therapist (SLT) to dietitian (RD) review once oral intake is commenced? (2) How long on average do patients keep NG in situ following commencement of ON? (3) Who is the main decision maker regarding NG removal? (4) How likely is a patient to meet their dietary target on the first review after NG removal, based on the decision maker? (5) Do particular SLT recommendations influence the likelihood of a patient meeting their dietary targets? (6) Does type of EN influence likelihood of patient meeting their overall nutrition targets?

Results After oral intake was commenced, only those receiving supplementary EN achieved nutritional targets immediately. Conversely, no patient who had their NG removed at this stage achieved these targets. Following NG removal, the likelihood of a patient meeting nutritional targets was influenced strongly by the decision maker, supporting the practice of RD led cessation of NG feeding. These findings led us to develop an ‘NG Transition Feeding Protocol (TFP)’ to serve as a simple, clear pathway which treating teams can utilise to guide NG feeding decisions.

Conclusions NG feeding supports neurosurgical patients to meet nutritional requirements in the early stages following commencement of oral intake. The development of an ‘NG Transition Feeding Protocol’ can help to improve consistency of transition feeding on neurosurgical wards, allowing adequate time for formal nutrition assessment to support informed decisions around NG removal. This model may improve the efficiency of transition feeding, improve dietetic workload efficiency, nursing staff confidence and avoid compromising nutritional status of patients due to early cessation of EN.

Acknowledgements We would like to acknowledge the Nutrition Education Policy in Healthcare Practice (NEPHELP) secondary care group for their consultation on this project.