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Barrocas A, Schwartz DB, Bistrian BR, Guenter P, Mueller C, Chernoff R, Hasse JM. Nutrition support teams: Institution, evolution, and innovation. Nutr Clin Pract 2023; 38:10-26. [PMID: 36440741 DOI: 10.1002/ncp.10931] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/29/2022] Open
Abstract
The historical institution, evolution, and innovations of nutrition support teams (NSTs) over the past six decades are presented. Focused aspects of the transition to transdisciplinary and patient-centered care, NST membership, leadership, and the future of NSTs are further discussed. NSTs were instituted to address the need for the safe implementation and management of parenteral nutrition, developed in the late 1960s, which requires the expertise of individuals working collaboratively in a multidisciplinary fashion. In 1976, the American Society for Parenteral and Enteral Nutrition (ASPEN) was established using the multidisciplinary model. In 1983, the United States established the inpatient prospective payment system with associated diagnosis-related groupings, which altered the provision of nutrition support in hospitals with funded NSTs. The number of funded NSTs has waxed and waned since; yet hospitals and healthcare have adapted, as additional education and experience grew, primarily through ASPEN's efforts. Nutrition support was not administered in some instances by the "core of four" (physician, nurse, dietitian, pharmacist). The functions may be carried out by a member of the core of four not associated with the parent discipline, in accordance with licensure/privileging. This cross-functioning has evolved into the adaptation of the concept of transdisciplinarity, emphasizing function over form, supported and enhanced by "top-of-license" practice. In some institutions, nutrition support has been incorporated into other healthcare teams. Future innovations will assist NSTs in providing the right nutrition support for the right patient in the right way at the right time, recognizing that nutrition care is a human right.
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Affiliation(s)
- Albert Barrocas
- Department of Surgery, Tulane University School of Medicine, Atlanta, Georgia, USA
| | - Denise Baird Schwartz
- Bioethics Committee, Providence Saint Joseph Medical Center, Burbank, California, USA
| | - Bruce R Bistrian
- Division of Clinical Nutrition, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition (ASPEN), Moses Lake, Washington, USA
| | - Charles Mueller
- Department of Nutrition and Food Studies, New York University/Steinhardt, New York, New York, USA
| | - Ronni Chernoff
- Donald Reynolds Institute of Aging, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jeanette M Hasse
- Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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2
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Barrocas A. Demonstrating the Value of the Nutrition Support Team to the C-Suite in a Value-Based Environment: Rise or Demise of Nutrition Support Teams? Nutr Clin Pract 2020; 34:806-821. [PMID: 31697446 DOI: 10.1002/ncp.10432] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Nutrition support teams (NSTs) in the United States have had to justify their existence since their inception in the 1970s. Concomitant with those efforts, changes in healthcare financing have challenged hospital administrators to adapt their reimbursement strategies and methods. NSTs, if they are to survive and/or thrive, must be aware of the convulsive currents of change faced by those who determine which programs move downstream and which find their demise on the banks of the stream. This review provides a historical perspective of both the US healthcare financing system and the NST experiences of nutrition clinicians over the past 4 decades. Focused discussions of 5 teams are provided from individual members of those varied NSTs. Additional recommendations from the administrative side of the equation are presented by 3 administrators. Whether NSTs will "rise or demise" depends on many factors. Understanding what those who control the purse strings are seeking in terms of salutary cost and quality outcomes in the current value-based system will facilitate the NST's communication with them. The demonstration of the NST's value is more likely to succeed when bolstered by current evidence-based data as applied to the specific institution. These efforts can be carried out by a formal NST in larger or academic institutions or a "virtual" team with a single individual coordinating the services in a transdisciplinary fashion, employing the acronym ACT (accountability, communication, [transdisciplinary] teamwork).
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Affiliation(s)
- Albert Barrocas
- WellStar Atlanta Medical Center, Atlanta, Georgia, USA.,Tulane School of Medicine, New Orleans, Louisiana, USA.,ALMA, LLC, Atlanta, Georgia, USA
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3
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Ukleja A, Gilbert K, Mogensen KM, Walker R, Ward CT, Ybarra J, Holcombe B. Standards for Nutrition Support: Adult Hospitalized Patients. Nutr Clin Pract 2018; 33:906-920. [DOI: 10.1002/ncp.10204] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Andrew Ukleja
- Beth Israel Deaconess Medical Center; Division of Gastroenterology; Boston Massachusetts USA
| | - Karen Gilbert
- Thomas Jefferson University Hospital; Philadelphia Pennsylvania USA
| | - Kris M. Mogensen
- Department of Nutrition; Brigham and Women's Hospital; Boston Massachusetts USA
| | - Renee Walker
- Michael E. DeBakey Veteran Affairs Medical Center; Houston Texas USA
| | | | - Joe Ybarra
- Medical City McKinney; McKinney Texas USA
| | - Beverly Holcombe
- American Society for Parenteral and Enteral Nutrition; Silver Spring Maryland USA
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Mantegazza C, Landy N, Zuccotti GV, Köglmeier J. Indications and complications of inpatient parenteral nutrition prescribed to children in a large tertiary referral hospital. Ital J Pediatr 2018; 44:66. [PMID: 29880053 PMCID: PMC5992672 DOI: 10.1186/s13052-018-0505-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/25/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Parenteral Nutrition (PN) is prescribed to children with intestinal failure. Although life saving, complications are common. Recommendations for indications and constituents of PN are made in the 2005 guidelines by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). The aim of this study was to establish if the indications for prescribing PN in a tertiary children's hospital were appropriate, and to identify complications encountered. Data were compared to those published by the National Confidential Enquiry into patient outcome and death (NCEPOD) carried out in the United Kingdom in 2010. METHODS Children and newborns receiving inpatient PN over a 6 months period were entered into the study and data was collected prospectively. The appropriate indications for the use of PN were based on the ESPGHAN guidelines. Recorded complications were divided into metabolic, central venous catheter (CVC) related, hepatobiliary and nutritional. RESULTS A total of 303 children (67 newborns) were entered into the study. The main indications for the start of PN were critical illness (66/303), surgery (63/303) and bone marrow transplantation (28/303). The ESPGHAN recommendations were followed in 91.7% (278/303) of cases (95.5% of newborns, 90.7% of children). PN was considered inappropriate in 12/303 patients and equivocal in 13. The mean PN duration was 18 days (1-160) and the incidence of complications correlated to the length of PN prescribed. Metabolic, hepatobiliary and CVC related complications affected 74.6, 24.4, 16.4% of newborns and 76.7, 37.7 and 24.6% of children respectively. In relation to the appropriate indications for the start of PN our results mirrored those reported by the NCEPOD audit (92.4% of newborns and 88.6% children). However, the incidence of metabolic disturbances was higher in our cohort (74.6% vs 30.4% in children, 76.7% vs 14.3% in newborns) but CVC related complications lower amongst our newborns (16,4% vs 25%). CONCLUSIONS Although the indications for inpatient PN in children is mostly justified, there is still a proportion who is receiving PN unnecessarily. PN related complications remain common. There is a need for better education amongst health professionals prescribing PN and access to nutritional support teams to reduce unwanted side effects.
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Affiliation(s)
- C. Mantegazza
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Department of Pediatrics, University of Milan, Ospedale dei Bambini Vittore Buzzi, Milan, Italy
| | - N. Landy
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - G. V. Zuccotti
- Department of Pediatrics, University of Milan, Ospedale dei Bambini Vittore Buzzi, Milan, Italy
| | - J. Köglmeier
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Toulson Davisson Correia MI. Addressing the Hidden Burden of Malnutrition for Hospitalized Patients. J Acad Nutr Diet 2017; 118:37-39. [PMID: 28416433 DOI: 10.1016/j.jand.2017.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/06/2017] [Indexed: 12/16/2022]
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Kochevar M, Guenter P, Holcombe B, Malone A, Mirtallo J. A.S.P.E.N. Statement on Parenteral Nutrition Standardization. JPEN J Parenter Enteral Nutr 2017; 31:441-8. [PMID: 17712154 DOI: 10.1177/0148607107031005441] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In response to questions regarding use of standardized parenteral nutrition (PN) formulations, the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) developed a Task Force to address some of these issues. A.S.P.E.N. envisions standardized PN as a broader issue rather than simply using a standardized, commercially available PN product. A standardized process for PN must be explored in order to improve patient safety and clinical appropriateness, and to maximize resource efficiency. A standardized process may include use of standardized PN formulations (including standardized, commercial PN products) but also includes aspects of ordering, labeling, screening, compounding, and administration of PN. A safe PN system must exist which minimizes procedural incidents and maximizes the ability to meet individual patient requirements. Using clinicians with nutrition support therapy expertise will contribute to that safe PN system. The purpose of this statement is to present the published literature associated with standardized PN formulations, to provide recommendations, and to identify areas in need of future research.
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Worthington P, Balint J, Bechtold M, Bingham A, Chan LN, Durfee S, Jevenn AK, Malone A, Mascarenhas M, Robinson DT, Holcombe B. When Is Parenteral Nutrition Appropriate? JPEN J Parenter Enteral Nutr 2017; 41:324-377. [PMID: 28333597 DOI: 10.1177/0148607117695251] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings.
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Affiliation(s)
| | - Jane Balint
- 2 Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | | | - Angela Bingham
- 4 University of the Sciences, Philadelphia, Pennsylvania, USA
| | | | - Sharon Durfee
- 6 Central Admixture Pharmacy Services, Inc, Denver, Colorado, USA
| | | | | | - Maria Mascarenhas
- 9 The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel T Robinson
- 10 Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Beverly Holcombe
- 11 American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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8
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Mirtallo JM, Powell CR, Campbell SM, Schneider PJ, Kudsk KA. Invited Review: Cost-Effective Nutrition Support. Nutr Clin Pract 2016. [DOI: 10.1177/088453368700200404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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9
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Dodds ES, Murray JD, Trexler KM, Grant JP. Metabolic Occurrences in Total Parenteral Nutrition Patients Managed by a Nutrition Support Team. Nutr Clin Pract 2016. [DOI: 10.1177/088453360101600204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Cimino MA, Claxton N, Manz C, Kelly T, Rossi TM. Experience of a Clinical Outcome-Based Pediatric Nutrition Support Service. Nutr Clin Pract 2016. [DOI: 10.1177/088453369901400507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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12
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Hamilton C, Boyce VJ. Addressing Malnutrition in Hospitalized Adults. JPEN J Parenter Enteral Nutr 2013; 37:808-15. [DOI: 10.1177/0148607113497224] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Chuah SW, Ng DHL, Liu P, Liu H, Ng JL, Ling KL. The Use of Parenteral Nutrition in an Acute Care Hospital. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n8p395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction: Parenteral nutrition (PN) is an important supportive therapy. However, it is expensive and associated with significant complications. Our aim is to describe the patients given PN in 2006, to compare with the 2001 cohort and determine if PN had been prescribed for the appropriate indications. Materials and Methods: A retrospective cohort study of adult patients receiving PN between January and December 2006 was undertaken in a single institution. Appropriateness of indications for PN was based on the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) guidelines 2002. Results: One hundred and eighty-two patients received 194 courses (102 males, 92 females) of PN. Median age was 62 years (range, 16 to 100). Eighty-two percent were surgical patients and 18% were medical patients. Median PN duration was 9 days (range, 2 to 115). Common indications were surgeons’ anticipation of non-functioning gut postoperatively [47 (24.2%) courses], postoperative complications [33 (17.0%) courses] and postoperative ileus [31 (16.1%) courses]. Indications for PN met A.S.P.E.N. guidelines in 93.3% of cases compared to 78.3% in 2001. In 1.5% of cases, we were unable to determine if the indications met the guidelines. Ten courses did not meet the guidelines; 3 had PN for <7 days preoperatively, 6 had PN because the managing team thought the patients were critically ill and 1 was given PN for refusal to eat because of depression. Conclusion: Since 2001, there has been an increase in the proportion of PN given for appropriate indications. However, physician education with respect to the benefit of PN for preoperative and critically ill patients with functioning guts needs reinforcing.
Key words: American Society for Parenteral and Enteral Nutrition (A.S.P.E.N) guidelines, Indications of Parenteral Nutrition, Inappropriate use of Parenteral Nutrition
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Affiliation(s)
| | | | - Peiyun Liu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Huimin Liu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jia Lin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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14
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Ukleja A, Freeman KL, Gilbert K, Kochevar M, Kraft MD, Russell MK, Shuster MH. Standards for nutrition support: adult hospitalized patients. Nutr Clin Pract 2011; 25:403-14. [PMID: 20702847 DOI: 10.1177/0884533610374200] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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15
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Martin K, DeLegge M, Nichols M, Chapman E, Sollid R, Grych C. Assessing Appropriate Parenteral Nutrition Ordering Practices in Tertiary Care Medical Centers. JPEN J Parenter Enteral Nutr 2010; 35:122-30. [DOI: 10.1177/0148607110362992] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kelley Martin
- Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina
| | - Mark DeLegge
- Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina
| | - Michele Nichols
- Center for Research in Nutrition and Health Disparities, University of South Carolina, Columbia, South Carolina
| | - Emily Chapman
- Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina
| | - Ronald Sollid
- Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina
| | - Catherine Grych
- Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina
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Nightingale J. Nutrition support teams: how they work, are set up and maintained. Frontline Gastroenterol 2010; 1:171-177. [PMID: 28839571 PMCID: PMC5517177 DOI: 10.1136/fg.2009.000224] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2010] [Indexed: 02/04/2023] Open
Abstract
Safe cost effective nutritional support is provided by a multidisciplinary team whose activity is overseen by a Nutrition Steering Group that reports directly to the Hospital Trust Board. When a nutrition support team (NST) is first formed, a nutrition nurse specialist enables parenteral nutrition to be given safely. An NST needs to have a clearly agreed scope of practice and needs to be able to justify its presence in terms of quality and cost savings.
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DeLegge M, Wooley JA, Guenter P, Wright S, Brill J, Andris D, Wagner P, Filibeck D. The State of Nutrition Support Teams and Update on Current Models for Providing Nutrition Support Therapy to Patients. Nutr Clin Pract 2010; 25:76-84. [DOI: 10.1177/0884533609354901] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Mark DeLegge
- American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), Silver Spring, Maryland
| | - Jennifer A. Wooley
- American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), Silver Spring, Maryland
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), Silver Spring, Maryland
| | - Sheila Wright
- American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), Silver Spring, Maryland
| | - Joel Brill
- American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), Silver Spring, Maryland
| | - Deb Andris
- American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), Silver Spring, Maryland
| | - Pam Wagner
- American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), Silver Spring, Maryland
| | - Don Filibeck
- American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), Silver Spring, Maryland
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18
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Guidelines for colorectal cancer: Effects on nutritional intervention. Clin Nutr 2007; 26:691-7. [DOI: 10.1016/j.clnu.2007.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 08/23/2007] [Accepted: 08/30/2007] [Indexed: 01/15/2023]
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Leite HP, Carvalho WBD, Santana e Meneses JF. Atuação da equipe multidisciplinar na terapia nutricional de pacientes sob cuidados intensivos. REV NUTR 2005. [DOI: 10.1590/s1415-52732005000600008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pacientes hospitalizados podem ter necessidades nutricionais especiais em função da desnutrição e dos desequilíbrios metabólicos impostos pelas doenças. A terapia nutricional, principalmente nos estágios críticos das enfermidades, deve ser administrada de modo seguro e eficaz. Vários estudos têm avaliado o papel da equipe multidisciplinar na administração da terapia nutricional. Com o objetivo de identificar os problemas inerentes à administração da terapia nutricional em pacientes hospitalizados e verificar o impacto da atuação de uma equipe multidisciplinar na qualidade dos procedimentos, foi realizada uma revisão que analisou artigos publicados entre 1980 e 2004 sobre o papel da atuação de equipes multidisciplinares no cuidado e na evolução nutricional de pacientes hospitalizados, principalmente os que se encontravam sob cuidados intensivos. Os termos utilizados na pesquisa foram: "multidisciplinary team", "nutritional support", "parente-ral nutrition", "enteral feeding", "critically ill", "intensive care unit","critically ill child". Dos 130 estudos inicialmente identificados, foram selecionados 24, dos quais 14 compararam o padrão de terapia nutricional com e sem a presença da equipe multidisciplinar. Os principais problemas detectados na administração de terapia nutricional em pacientes hospitalizados foram a oferta inadequada de nutrientes, as complicações infecciosas e metabólicas e o uso excessivo de nutrição parenteral. Nos estudos comparativos, a presença da equipe multidisciplinar melhorou o padrão de oferta nutricional, reduziu a incidência de complicações e os custos.
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Affiliation(s)
- Heitor Pons Leite
- Universidade Federal de São Paulo, Brasil; Hospital São Paulo, Brasil
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20
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Kennedy JF, Nightingale JMD. Cost savings of an adult hospital nutrition support team. Nutrition 2005; 21:1127-33. [PMID: 16308136 DOI: 10.1016/j.nut.2005.08.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2005] [Accepted: 06/21/2005] [Indexed: 01/10/2023]
Abstract
OBJECTIVES A hospital-based nutrition support team (NST) may need to demonstrate cost savings and quality benefits. The primary aim of this study was to determine whether an NST could show tangible cost savings (equipment, investigations, and medication costs) from managing patients considered for parenteral nutrition (PN). Secondary aims related to the quality issues of placement of PN catheters, catheter-related sepsis (CRS), duration of parenteral nutrition, and mortality. METHODS An NST was formed in 1999 and worked in all adult areas of a university hospital (Leicester Royal Infirmary). Comparative data about all patients given PN were collected for 2 consecutive years (a retrospective pre-NST year and a prospective NST year). RESULTS In the pre-NST year there were 82 PN episodes (54 patients), 665 PN days, and a CRS rate of 71% (seven infections/100 PN days). In the NST year, there were 133 referrals for PN but only 78 PN episodes (75 patients, 59% of referrals), 752 PN days, and a decreased overall CRS rate of 29% (three infections/100 PN days, P < 0.05) but a rate of 7% (0.6 infection/100 PN days) in the final 3 mo of the NST year. Tangible cost savings for the NST year were derived from 55 avoided PN episodes (42741 pounds sterlings) and 35 avoided CRS episodes (7974 pounds sterlings). Thirty-nine percent of PN catheters were inserted by the NST with no insertion-related complications. Competency-based training of ward nursing staff decreased the CRS rate. Mean duration of PN increased from 8 to 10 d (P not significant). In-hospital mortality for patients who had PN was 23 of 54 (43%) in the pre-NST year compared with 18 of 75 (24%) in the NST year (P < 0.05). CONCLUSIONS Although the number of PN days increased with an NST, tangible cost savings of 50715 pounds sterlings were demonstrated within the NST year by avoided PN episodes and a decreased incidence of CRS. These savings justify the salaries of a nutrition nurse specialist and a senior dietitian.
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21
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The Multidisciplinary Approach to Enteral Nutrition. Clin Nutr 2005. [DOI: 10.1016/b978-0-7216-0379-7.50005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Saalwachter A, Evans H, Willcutts K, O'Donnell K, Radigan A, Mcelearney S, Smith R, Chong T, Schirmer B, Pruett T, Sawyer R. A Nutrition Support Team Led by General Surgeons Decreases Inappropriate Use of Total Parenteral Nutrition on a Surgical Service. Am Surg 2004. [DOI: 10.1177/000313480407001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to decrease the number of inappropriate orders for total parenteral nutrition (TPN) in surgical patients. From February 1999 through November 2000 and between July 2001 and June 2002, the surgeon-guided adult nutrition support team (NST) at a university hospital monitored new TPN orders for appropriateness and specific indication. In April 1999, the NST was given authority to discontinue inappropriate TPN orders. Indications, based on the American Society for Parenteral and Enteral Nutrition (ASPEN) standards, included short gut, severe pancreatitis, severe malnutrition/catabolism with inability to enterally feed ≥5 days, inability to enterally feed ≥50 per cent of nutritional needs ≥9 days, enterocutaneous fistula, intraabdominal leak, bowel obstruction, chylothorax, ischemic bowel, hemodynamic instability, massive gastrointestinal bleed, and lack of abdominal wall integrity. The number of inappropriate TPN orders declined from 62/194 (32.0%) in the first 11 months of the study to 22/168 (13.1%) in the second 11 months ( P < 0.0001). This number further declined to 17/215 (7.9%) in the final 12 months of data collection, but compared to the second 11 months, this decrease was not statistically significant ( P = 0.1347). The involvement of a surgical NST was associated with a reduction in inappropriate TPN orders without a change in overall use.
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Affiliation(s)
- A.R. Saalwachter
- From the University of Virginia Health System, Charlottesville, Virginia
| | - H.L. Evans
- From the University of Virginia Health System, Charlottesville, Virginia
| | - K.F. Willcutts
- From the University of Virginia Health System, Charlottesville, Virginia
| | - K.B. O'Donnell
- From the University of Virginia Health System, Charlottesville, Virginia
| | - A.E. Radigan
- From the University of Virginia Health System, Charlottesville, Virginia
| | - S.T. Mcelearney
- From the University of Virginia Health System, Charlottesville, Virginia
| | - R.L. Smith
- From the University of Virginia Health System, Charlottesville, Virginia
| | - T.W. Chong
- From the University of Virginia Health System, Charlottesville, Virginia
| | - B.D. Schirmer
- From the University of Virginia Health System, Charlottesville, Virginia
| | - T.L. Pruett
- From the University of Virginia Health System, Charlottesville, Virginia
| | - R.G. Sawyer
- From the University of Virginia Health System, Charlottesville, Virginia
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Babakissa C, Lacote-Popovic S, Colombani JF, Balan JG. Risque nutritionnel en milieu hospitalier. CAHIERS DE NUTRITION ET DE DIETETIQUE 2004. [DOI: 10.1016/s0007-9960(04)94342-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Abstracts of Original Communications. Proc Nutr Soc 2001. [DOI: 10.1017/s0029665101000027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Trujillo EB, Young LS, Chertow GM, Randall S, Clemons T, Jacobs DO, Robinson MK. Metabolic and monetary costs of avoidable parenteral nutrition use. JPEN J Parenter Enteral Nutr 1999; 23:109-13. [PMID: 10082002 DOI: 10.1177/0148607199023002109] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We prospectively collected data on in patients receiving parenteral nutrition to determine the magnitude of potentially preventable metabolic and monetary costs associated with parenteral nutrition. METHODS Parenteral nutrition was prescribed by the treating physicians with optional consultation from a multidisciplinary metabolic support service. Days on parenteral nutrition, appropriateness of parenteral nutrition, metabolic complications, and avoidable parenteral nutrition charges were determined. Parenteral nutrition use was considered "indicated" or "not indicated" based on the American Society for Parenteral and Enteral Nutrition guidelines and "preventable" if the gastrointestinal tract was functional but not accessed when possible. RESULTS Of the 209 parenteral nutrition starts, 62% were indicated, 23% were preventable, and 15% were not indicated. Parenteral nutrition starts were deemed indicated in 82% of instances in which a metabolic support service consult was obtained, compared with 56% in which a consultation was not obtained (p = .004). Hyperglycemia was the most common metabolic complication, with an overall incidence of 20%. Metabolic complications occurred less frequently in patients who received a metabolic support service consultation compared with patients who did not (34% vs 66% of parenteral nutrition days, respectively; p = .004). Parenteral nutrition use of < or =5 days duration was significantly less frequent among patients who received metabolic support service consultation (16% vs 35%; p = .002). Parenteral nutrition that was not indicated or preventable resulted in excess annualized patient charges of more than one half million dollars not accounting for charges related to treatment of potentially avoidable parenteral nutrition complications. CONCLUSIONS This study illustrates that not-indicated and preventable parenteral nutrition initiation, short-term parenteral nutrition use, and metabolic complications are less likely when patients receive consultation by a multidisciplinary team with expertise in nutrition and metabolic support. Furthermore, the avoidance of inappropriate parenteral nutrition use translates into substantial cost savings.
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Affiliation(s)
- E B Trujillo
- Metabolic Support Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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26
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Israel D, Garritson B. The Role of the Registered Dietitian in Home Health Care: Definition and Efficacy. HOME HEALTH CARE MANAGEMENT AND PRACTICE 1998. [DOI: 10.1177/108482239801000613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lanoir D, Chambrier C, Vergnon P, Meynaud-Kraemer L, Wilkinson J, Mcpherson K, Bouletreau P, Colin C. Perioperative artificial nutrition in elective surgery: an impact study of French guidelines. Clin Nutr 1998; 17:153-7. [PMID: 10205333 DOI: 10.1016/s0261-5614(98)80051-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE In France, the consensus conference, held on 16 December 1994, produced guidelines on perioperative artificial nutrition (AN) use in patients undergoing elective surgery. The aim of this study was to assess the impact of these guidelines on practice patterns. METHODS The study was a practice pattern study with a 'before-after' design and a control group in England. A retrospective cross-sectional sample of adult patients undergoing elective resection of the digestive tract was collected in France and England before and after the consensus conference. RESULTS Malnourished patients received postoperative AN in 94% of 'before' cases and 82% 'after' but inadequate preoperative AN (40% 'before' and 26% 'after'). Postoperative AN appeared to be over-prescribed in non-malnourished patients without prolonged postoperative fasting (70% 'before' and 65% 'after'). In the English sample there was no significant variation in AN use between 'before' and 'after' periods. CONCLUSION This study shows that clinical guidelines disseminated by consensus conference had a low impact on practice patterns in France and thus confirms the need to enforce the dissemination of the guidelines.
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Affiliation(s)
- D Lanoir
- Départment d'Information Médicale - Hôpital de l'Hôtel-Dieu, Lyon, France
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Bowman, LC, Williams R, Sanders M, Ringwald-Smith K, Baker D, Gajjar A. Algorithm for nutritional support: Experience of the metabolic and infusion support service of St. Jude Children's Research Hospital. Int J Cancer 1998. [DOI: 10.1002/(sici)1097-0215(1998)78:11+<76::aid-ijc22>3.0.co;2-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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Affiliation(s)
- J Payne-James
- Department of Gastroenterology and Nutrition, Central Middlesex Hospital, London, United Kingdom
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30
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Frost P, Bihari D. The route of nutritional support in the critically ill: physiological and economical considerations. Nutrition 1997. [DOI: 10.1016/s0899-9007(97)83045-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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31
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Maurer J, Weinbaum F, Turner J, Brady T, Pistone B, D'Addario V, Lun W, Ghazali B. Reducing the inappropriate use of parenteral nutrition in an acute care teaching hospital. JPEN J Parenter Enteral Nutr 1996; 20:272-4. [PMID: 8865108 DOI: 10.1177/0148607196020004272] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Parenteral nutrition (PN) is a form of nutrition that can be life-saving, but its use has inherent risks and it is expensive. Nutrition support teams have been shown to reduce both the rate of complications and excessive use of PN. METHODS Criteria were established to evaluate the appropriateness of PN use in a 487-bed community teaching hospital. A prospective study of 50 consecutive patients, who received either central or peripheral PN, was conducted. RESULTS The 50 patients received 469 days of PN. We found that 233 (49.7%) of the 469 days of PN were avoidable. This resulted in the creation of a formal approval process that required prior approval by a physician-directed multidisciplinary advisory committee before PN could be instituted. The amount of PN subsequently decreased from 500 patient days of PN per month to less than 100. CONCLUSIONS This study supports the idea that inappropriate use of PN can be reduced by physician education plus the continuing oversight of a physician-directed multidisciplinary advisory group.
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Affiliation(s)
- J Maurer
- New York Hospital, Medical Center of Queens, Flushing 11355, USA
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ChrisAnderson D, Heimburger DC, Morgan SL, Geels WJ, Henry KL, Conner W, Hensrud DD, Thompson G, Weinsier RL. Metabolic complications of total parenteral nutrition: effects of a nutrition support service. JPEN J Parenter Enteral Nutr 1996; 20:206-10. [PMID: 8776694 DOI: 10.1177/0148607196020003206] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effectiveness of Nutrition Support Services in optimizing parenteral nutrition has not been evaluated since the 1980s. METHODS We prospectively monitored medical and surgical patients on total parenteral nutrition (TPN) in a university hospital who did not receive Nutrition Support Service recommendations to compare the incidence of metabolic complications in 1979 (group 1, n = 100) with that in 1992 (group 2, n = 106). The Service provided automatic recommendations on a subsequent group of medical service patients (group 3, n = 128) and compared them with the patients in group 2 who were on the medical service (group 2B, n = 29). RESULTS Statistically significant changes between 1979 and 1992 included a decline in the incidence of hyperglycemia from 47% to 22% and in hypokalemia from 12% to 3% of surgical patients and an increase in hypomagnesemia from 0% to 23% of surgical patients and from 2% to 14% of medical patients. The incidence of hypophosphatemia remained > 20% in both medical and surgical patients. Within 1992, the addition of automatic recommendations had little impact on metabolic abnormalities and was associated with slightly but insignificantly lower TPN costs (not counting Service personnel costs). CONCLUSIONS Factors such as the general integration of parenteral nutrition into tertiary medical care, standard protocols and order forms, automatic Nutrition Support Service consultations in an affiliated hospital, and nutrition curricula may be responsible for the improvements seen since 1979. However, the addition of automatic Service consultation in 1992 had only a marginal effect on metabolic complications and costs of parenteral nutrition.
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Affiliation(s)
- D ChrisAnderson
- Department of Nutrition Sciences and Medicine, University of Alabama at Birmingham, USA
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Gallagher-Allred CR, Voss AC, Finn SC, McCamish MA. Malnutrition and clinical outcomes: the case for medical nutrition therapy. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1996; 96:361-6, 369; quiz 367-8. [PMID: 8598437 DOI: 10.1016/s0002-8223(96)00099-5] [Citation(s) in RCA: 162] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Malnutrition is not a new or a rare problem. In studies involving more than 1,327 hospitalized adult patients, 40% to 55% were found to be either malnourished or at risk for malnutrition, and up to 12% were severely malnourished. Surgical patients with likelihood of malnutrition are two to three times more likely to have minor and major complications as well as increased mortality; and their length of stay can be extended by 90% compared with the stay of well-nourished patients. Hospital charges are reported to be from 35% to 75% higher for malnourished patients than for well-nourished patients. Obtaining data to assess the nutritional status of patients is essential to optimal patient care, especially for patients at high risk for malnutrition. Nutrition assessment can be done with readily available and relatively inexpensive methods. But it is not enough to assess and identify malnutrition. Outcomes are improved and costs are saved only when appropriate intervention follows. This article identifies many well-conducted, published studies that support the findings that health outcomes of malnourished patients can be improved and that overall use of resources can be reduced by nutrition counseling, oral diet and oral supplements, enteral formula delivered via tube, and parenteral nutrition support via central or peripheral line. Early nutrition assessment and appropriate nutrition intervention must be accepted as essential for the delivery of quality health care. Appropriately selected nutrition support can address the problem of malnutrition, improve clinical outcomes, and help reduce the costs of health care.
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Cerra FB, Kaplan EL, Schwarzenberg SJ, Soltis R, Twiggs L. A managed care model for home infusion therapy. Am J Med Qual 1995; 10:93-9. [PMID: 7787505 DOI: 10.1177/0885713x9501000206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Home infusion therapy began in response to the medical needs of the patients. In the traditional model, products and services were delivered in the home on a physician's prescription. Limitations related to medical quality management and cost were recognized in this model. Because of these limitations, the changes that continue to occur in health care delivery and the increase in number and acuity of patients requiring non-hospital services, a managed care model was conceived and implemented at the University of Minnesota Medical School and Hospital. This model emphasizes physician-based case management, total quality management, a point of contact medical information system, outcomes assessment and management, and research and education activities designed to evaluate and improve home infusion therapies. The model was implemented through a public-private partnership. This application of managed care to home infusion therapies is described in this communication.
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Affiliation(s)
- F B Cerra
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
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Pironi L, Tognoni G. Cost-benefit and cost-effectiveness analysis ofhome artificial nutrition: reappraisal of available data. Clin Nutr 1995; 14 Suppl 1:87-91. [PMID: 16843983 DOI: 10.1016/s0261-5614(95)80292-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- L Pironi
- Institute of Internal Medicine and Gastroenterology, University of Bologna, St. Orsola Hospital, Bologna, Italy
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Hassell JT, Games AD, Shaffer B, Harkins LE. Nutrition support team management of enterally fed patients in a community hospital is cost-beneficial. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1994; 94:993-8. [PMID: 8071497 DOI: 10.1016/0002-8223(94)92192-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine whether nutrition support team (NST) management of enterally fed patients is cost-beneficial and to compare primary outcomes of care between team and nonteam management. DESIGN A quasi-experimental study was conducted over a 7-month period. SETTING A 400-bed community hospital. SUBJECTS A convenience sample of 136 subjects who had received enteral nutrition support for at least 24 hours. Forty-two patients died; only their mortality data were used. Ninety-six patients completed the study. INTERVENTION Outcomes, including cost, for enterally fed patients in two treatment groups--those managed by the nutrition support team and those managed by nonteam staff--were compared. MAIN OUTCOME MEASURES Severity of illness level was determined for patients managed by the nutrition support team and those managed by nonteam staff. For each group, the following measures were adjusted to reflect a significant difference in average severity of illness and then compared: length of hospital stay, readmission rates, and mortality rates. Complication rates between the groups were also compared. The cost benefit was determined based on savings from the reduction in adjusted length of hospital stay. STATISTICAL ANALYSES PERFORMED Parametric and nonparametric statistics were used to evaluate outcomes between the two groups. RESULTS Differences were statistically significant for both severity of illness, which was at a higher level in the nutrition support team group (P < .001), and complication rate, which was greater in the nonteam group (P < .001). In the nutrition support team-managed group, there was a 23% reduction in adjusted mortality rate, an 11.6% reduction in the adjusted length of hospital stay, and a 43% reduction in adjusted readmission rate. Cost-benefit analysis revealed that for every $1 invested in nutrition support team management, a benefit of $4.20 was realized. APPLICATIONS Financial and humanitarian benefits are associated with nutrition support team management of enterally fed hospitalized patients.
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Affiliation(s)
- J T Hassell
- Trumbull Memorial Hospital, Warren, OH 44482
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Gilbride JA, Parks SC, Palakurthi RR. Attitudes and opinions of dietetics professionals toward cost-benefit and cost-effectiveness analyses. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1994; 94:386-9. [PMID: 8144804 DOI: 10.1016/0002-8223(94)90091-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To compare the attitudes and opinions of dietitians and dietary managers in regard to cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA). DESIGN A questionnaire was sent nationwide to a sample of 1,074 dietitians and 454 dietary managers. SUBJECTS/SAMPLES The dietitians were randomly selected from three dietetic practice groups of The American Dietetic Association that have practitioners with administrative responsibilities in health care: Clinical Nutrition Management, Consultant Dietitians in Health Care Facilities, and Management in Healthcare Systems. The random sample of dietary managers was drawn from the membership list of the Dietary Managers Association. MAIN OUTCOME MEASURES We hypothesized that there would be a difference between the dietitians and dietary managers in their attitudes about, and experiences in conducting CBA and CEA. STATISTICAL ANALYSES Data analysis incorporated frequencies, means, and standard deviations to describe the respondents. Pearson's pairwise correlations and analysis of variance examined the significance of the relationships among the variables of the study. Scheffe's test was conducted to identify which variables related closely to each other. RESULTS Seven hundred twenty-two usable questionnaires were returned, which gave an overall response rate of 47%. Although both professional groups had experience with reducing costs at their jobs, they did not think it important to conduct CBA and CEA. Neither group could distinguish between CBA and CEA. Dietitians, who were more positive toward using CBA and CEA, saw them as important techniques that could justify the value of dietetics services. Dietitians were also more likely than the dietary managers to use the techniques in the future. Dietitians were beginning to explore the techniques, but they did not feel that good sources of information were available for conducting CBA and CEA studies. APPLICATIONS/CONCLUSIONS Our findings suggest a strong need to educate dietitians and dietary managers in the techniques and proper use of CBA and CEA in practice settings. Dietitians need to be guided to appropriate teaching materials and educational programs, and dietary managers first have to be educated about the importance and the benefits of using the techniques.
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Affiliation(s)
- J A Gilbride
- Department of Nutrition, Food and Hotel Management, New York University, NY 10012-1172
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Abstract
OBJECTIVE To evaluate the literature describing the influence of nutritional support teams (NSTs) on the provision of nutritional therapy. DATA SOURCES A MEDLINE and International Pharmaceutical Abstracts search (key terms: nutritional support, nutritional support service/team, hyperalimentation service/team, metabolic support service/team, service/team) covering 1970-1993 were used to identify pertinent literature. STUDY SELECTION The results of comparative trials involving NSTs are presented. DATA EXTRACTION Data from comparative trials examining the influence of NSTs on the provision of enteral nutrition (EN) and total parenteral nutrition are discussed. DATA SYNTHESIS NSTs dramatically reduced the incidence of catheter-related complications, especially sepsis, by developing central venous catheter insertion and care guidelines. Early studies found that NSTs reduced the incidence of electrolyte and metabolic abnormalities by more stringent laboratory and clinical monitoring, but this was not found consistently in later studies. The ability of consultative NSTs to reduce the incidence of metabolic and electrolyte abnormalities is less clear. NSTs also were more likely to evaluate, document, and subsequently meet a patient's nutritional requirements. Studies examining the financial impact of NSTs frequently reported cost savings, but often failed to include personnel costs in their analysis. The provision of EN by an NST reduced the frequency of complications and increased the adequacy of nutritional supplementation. CONCLUSIONS Early nutritional support teams produced significant benefits largely through the development of protocols and standardization. Current NSTs should increase the dissemination of information supporting their continued benefits. To remain viable, NSTs need to expand their roles, document improved patient outcomes, and show cost-effectiveness.
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Affiliation(s)
- B J Gales
- Department of Pharmacy Practice, School of Pharmacy, Southwestern Oklahoma State University, Weatherford
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Plester CE, Fearon KC, Richardson R, Rogers P, Sedgwick C, McWhirter J, Reddy H, Garden OJ. Audit of nutritional support provided to surgical patients by a nutrition team. Clin Nutr 1993; 12:310-6. [PMID: 16843331 DOI: 10.1016/0261-5614(93)90051-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/1993] [Accepted: 05/25/1993] [Indexed: 11/17/2022]
Abstract
An audit was carried out over a 24 month period to assess the practice, safety and efficacy of nutritional support provided to surgical patients by a designated team. 135 patients received nutritional support: 51% were fed parenterally, 32% enterally and 17% via combined nutritional support. The duration of feeding ranged from 1-177 days with 23% being supported for < 7 days. The line infection rate for patients receiving intravenous nutrition was 6.5%. Nutritional outcome was assessed using weight, anthropometry and bioelectrical impedance analysis. Pre-and post-feeding results were available for 67% of patients. These patients were classified as either oedematous (n = 21), normally nourished (n = 23) or nutritionally depleted (n = 46). Overall, the oedematous patients lost water, the protein status of the normally nourished group deteriorated slightly and the nutritional status of the nutritionally depleted patients was maintained. Audit is a valuable means of defining the efficacy of a nutrition support service and has identified areas which require review.
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Affiliation(s)
- C E Plester
- University Department of Surgery, The Royal Infirmary, Lauriston Place, Edinburgh, EH3 9YW, UK
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Abstract
Providing nutrition support may be costly to hospitals under the prospective payment system. A nutrition support team, however, can be effective in controlling costs. To demonstrate the importance of the nutrition support team and to quantify the potential cost savings that can be achieved, a retrospective review of the effect of our team on hospital costs was conducted for the 12-month period of October 1989 to September 1990. The team supervises but does not regulate the use of total parenteral nutrition (TPN). During this time period, 176 patients received TPN. In 14 patients, the use of TPN was inappropriate, representing $65,349 in excess costs. After the cost of providing enteral nutrition to these patients (estimated at $2,430) was deducted, a net loss of $62,919 occurred. Nutrition support team action saved an additional $45,186 in hospital charges when recommendations to discontinue TPN were eventually heeded. Nutrition support team approval before TPN is initiated would achieve cost savings.
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Affiliation(s)
- S.M.G. McLaren
- Director of undergraduate studies, Department of Nursing and Midwifery, University of Surrey, Guildford
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Balet A, Cardona D. Importance of a nutrition support team to promote cost containment. Ann Pharmacother 1992; 26:265. [PMID: 1554948 DOI: 10.1177/106002809202600228] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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MacFarlane K, Bullock L, Fitzgerald JF. A usage evaluation of total parenteral nutrition in pediatric patients. JPEN J Parenter Enteral Nutr 1991; 15:85-8. [PMID: 1901113 DOI: 10.1177/014860719101500185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Records of 20 consecutive pediatric patients receiving total parenteral nutrition over a 1-month period were reviewed for appropriateness of nutritional assessment and management. Each patient was monitored until total parenteral nutrition was discontinued or for a maximum of 2 weeks. A total of 124 therapy days were reviewed. Results demonstrated that only 35% of these patients had a nutritional assessment performed prior to initiation of therapy, and only 65% had nutritional goals determined. Nutritional goals were defined as patient-specific goals for fluid volume (FV), calories, protein, and fat emulsion. Analysis of data demonstrated that goals for FV were met on 62% of therapy days. Of the days on which FV goals were met, goals for calories, protein, and fat emulsion were met on 54%, 59%, and 51% of therapy days, respectively. Baseline serum triglyceride levels were measured in one of 20 patients. Serial laboratory monitoring was adequate, with the exception of hepatic enzymes and serum triglycerides, which were measured in 14 and 9 patients, respectively. Recommendations for pediatric parenteral nutrition therapy are discussed, as well as methods to implement these recommendations.
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Affiliation(s)
- K MacFarlane
- Purdue University, West Lafayette, Indianapolis, Indiana
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Intérêt d'une équipe spécialisée pour la prévention des infections liées aux cathéters intravasculaires. NUTR CLIN METAB 1991. [DOI: 10.1016/s0985-0562(05)80119-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- J Payne-James
- Department of Gastroenterology and Nutrition, Central Middlesex Hospital, London
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46
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Position of The American Dietetic Association: Nutrition monitoring of the home parenteral and enteral patient. ACTA ACUST UNITED AC 1989. [DOI: 10.1016/s0002-8223(21)02110-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
This paper discusses the reasons for a paediatric nutritional care team, the members involved, and their role within the team. The methods used for nutritional assessment are described and the cost effectiveness of the nutrition team's involvement is discussed.
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Mirtallo JM, Oh T. A key to the literature of total parenteral nutrition: update 1987. DRUG INTELLIGENCE & CLINICAL PHARMACY 1987; 21:594-606. [PMID: 3111809 DOI: 10.1177/1060028087021007-805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This comprehensive bibliography is intended to enhance the education of the practitioner, student, and academician in the area of parenteral nutrition. This bibliography is not all-inclusive but serves as an update from the original published in 1983. Of particular note in this work is the addition of topics that reflect a growing interest in medical specialties with regard to patient nutritional status and support.
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