Amy Berry

“(Patients) no longer need to rely on someone being there with them as their ‘third arm’.” - Amy

What is your background and what led you to start your company, Enteral by Nutrition Support Specialty Care, LLC?

I’ve worked as a Registered Dietitian for 20 years now, most of my time spent at 2 large academic teaching centers as a Nutrition Support Specialist (which means specializing in Tube Feedings and TPN/ IV nutrition).  I was first at the Medical University of South Carolina, before moving back near home to work at the University of Virginia Health System in Charlottesville VA.  These centers are known for their excellence and expertise in patient care. However, even at these large centers, I have seen patients discharging from the system falling through the cracks.  What happens when the medically complex patient goes home? Whose responsibility do they become and where do they go for nutritional help? How about at even smaller facilities that don’t have the resources the larger facilities have? Where do their patients go for help with their tube feedings? Unfortunately, many patients leave without the support they need to be successful at home, so once home, they become more malnourished and end up being readmitted to the hospital.

Instead of being tied to just one facility, I thought, “What if I can all I have learned in caring for these patients and offer it to everyone everywhere?” So with that, my company Enteral was born! I have already recruited an experienced colleague of mine Kristen Quisenberry, RD, CNSC, and as we grow, we have other excellent nutritional colleagues ready to jump in to care for all the patients out there in need of help!​

We hear often about the gaps in care for enteral patients. Why do you think this is occurring?

I think many patients have seen and felt the fast track to discharge that occurs in the US. Many clinicians are feeling the pressure to see more patients in less time. I think of what patients go through that have never seen a tube before they get one placed into their body, and the next day (or often the same day!) they are sent out the door with little information. They are expected to know how to care for the tube, and how to troubleshoot tolerance of their tube feeding- which they are dependent on to stay hydrated, thrive… and survive.

The way the current system works, the patient is dependent on their discharging physician (oncologist, surgeon, gastroenterologist, general practitioner, etc) to do the job that was done by multiple teams while the patient was in the hospital. Often their outpatient clinics do not include nutrition specialists, and if they do, it is one person staffed for thousands of patients.  For example, many cancer centers remain vastly understaffed with Registered Dietitians. Looking at 215 cancer centers in the United States, most cancer centers only employ 1-2 dietitians (Trujillo et al, 2019). On average, this means 1 dietitian to cover 2,308 patients!

A stopgap has been some of the home infusion company dietitians. However, they are also vastly understaffed for the number of patients they cover. With the healthcare economy being what it is post COVID, these non-revenue generating clinical support positions are feeling the squeeze. In the last year alone, two major home infusion companies cut their clinical support staff in half! So now where are their patients going when they need help?

Why do you think specialized nutrition support to patients at home, like your company provides, is overall beneficial to the patient?

Two studies published (Hall et al, 2014, NCP & Emmons, 2022, NCP) have shown that improving tube education in conjunction with increased RD follow-up after tube placement markedly reduces ER visits, readmissions and tube complications.  In cancer patients, a study published in 2021 found that just seeing a dietitian one time actually did not make any difference. But when there were repeated visits with a dietitian (3 or more), this multicenter study found the patients had significantly less weight loss. Another study done in 2017 found that 8-9 nutrition interventions over a period of 4.5 months improved weight gain, decreased hospital admissions, hospital length of stay, tolerance of cancer treatment, and overall improved quality of life. Most people do not get this amount of care and attention post discharge. So, I created my company Enteral to fill this gap to help prevent readmissions and nutritional decline, and ultimately provide better outcomes.

How do you feel the FreeArm can support your patients and families?

I have always told my patients (usually my head and neck cancer patients) you need a “third arm to make bolus feeding easier!” And I love that the FreeArm company just went right ahead and invented that third arm! My favorite thing about this is the freedom and security it provides our patients. They no longer need to rely on someone being there with them as their “third arm” when they are not in the security of their own home. And it even makes feeding at home quite a bit easier! It is wonderful to see products in the market that are there to customize the patient’s experience and ease of feeding, therefore reducing unnecessary barriers to feeding and improved nutrition.

What services do you offer and how can people reach you if they need support? 

We support patients >18 years of age. Reach out to us to schedule a quick 10-minute phone call! An introduction phone call with us is completely free of charge. I want to make sure we are a good fit for the patient and can truly help them reach their goals. If I can’t help, there is a good chance I could suggest someone who can.

Our website: www.EnteralSupport.com

Facebook and Instagram as @tubefeedingdietitian

We can help more than just patients living in South Carolina and Virginia. Currently it varies state to state if a Registered Dietitian licensed in one state can provide nutrition care for patients in another state via telehealth (reciprocity). For each patient that contacts us, we verify their state’s laws. I am also working to become licensed in multiple states. Enteral uses a billing company, and we are fervently working state to state to become in-network providers. We have also found that even out-of-network providers may have some nutrition coverage. We never know potential coverage until we try! I also take out of pocket payment if insurance is not an option.

If nothing else, I encourage everyone to reach out and let’s see what can be done to meet the patient’s nutritional goals!