Patients with short bowel syndrome (SBS) may present in an acute care setting for many reasons, including diarrhea, dehydration, bowel obstruction, gallstones, and complications related to parenteral nutrition (PN) such as infections. In this Clinical Commentary video with accompanying downloadable infographic, physicians, nurses, NPs, and PAs within the urgent care and emergency department settings will learn about SBS, common complications, and strategies for reducing the risk of future complications, including pharmacologic options for enhancing intestinal adaptation that can lead to meaningful reductions in PN requirements, thereby reducing the incidence of PN-related complications in patients with SBS. 

This activity is intended for NPs, PAs, nurses, and other clinicians practicing in an urgent care or emergency room setting. 

Short bowel syndrome (SBS) is a malabsorptive condition that can occur after resection of portions of the small intestine that results in the inability to maintain appropriate homeostasis in electrolyte balance, fluid absorption, and nutritional intake, leading to significant impacts on quality of life and overall morbidity and mortality. Dietary therapy is the most crucial aspect of care for patients with SBS as both a primary life-sustaining intervention and also a mechanism for rehabilitating the remaining bowel; this includes not only careful management of enteral intake but also individualized PN when needed. Similarly, oral fluid therapy and careful assessment of hydration status are also essential, and the needs of an individual patient often vary according to which portions of the bowel remain. However, management of SBS is highly complex and is associated with a wide variety of common complications that may lead patients to present in an urgent care or emergency setting, including diarrhea, dehydration, bowel obstruction, gallstones, and GI bleeding. In addition, complications related to parenteral nutrition (PN) such as infections, occlusion, and breakage also commonly occur and cause patients to present for emergency care. Clinicians in the urgent care or emergency room setting have an opportunity to counsel patients and caregivers on strategies to reduce the incidence of SBS-related complications as well as those complications related to PN. Although appropriate catheter care is an important point of emphasis, long-term options to decrease the risk of PN-related complications through reduction or elimination of the need for PN could be even more meaningful. As such, clinicians within the urgent care and emergency department settings can provide insights on PN weaning at point-of-care and triage patients to specialty care. Educating patients about options for PN weaning, including intestinotrophic agents such as teduglutide, could lead to meaningful reductions in PN requirements that would, in turn, reduce the incidence of PN-related complications. To realize this outcome, education of nurses, NPs, and PAs about complications faced by patients with SBS and strategies to address these complications in the acute setting, as well as best practices for referral to specialty care to pursue avenues for PN weaning are critical.

Upon completion of this activity, participants will be able to:
• Describe complications that are associated with parenteral nutrition in patients with SBS 
• Identify strategies for preventing complications associated with SBS and parenteral nutrition
• Implement system-based tools and best practices for providing coordinated, multidisciplinary care for patients with SBS during and after emergency care

Sponsored by Rush University Medical Center and the Academy for Continued Healthcare Learning (ACHL)

Supported by an educational grant from Takeda Pharmaceuticals, U.S.A.