Enteral nutritional support management in a university teaching hospital: team vs nonteam

Abstract

Current hospital cost containment pressures have prompted a critical evaluation of whether nutritional support teams render more clinically effective and efficient patient care than nonteam management. To address this question with regard to enteral feeding, 102 consecutive hospitalized patients who required enteral nutritional support (ENS) by tube feeding during a 3 1/2-month period were prospectively studied. Fifty patients were managed by a nutritional support team; the other 52 were managed by their primary physicians. Choice of enteral formula, formula modifications, frequency of laboratory tests, and amounts of energy and protein received were recorded daily. In addition, each patient was monitored for pulmonary, mechanical, gastrointestinal, and metabolic abnormalities. Team-managed (T) and nonteam-managed (NT) patients received ENS for 632 and 398 days, respectively. The average time period for ENS was significantly longer in the team-managed patients (12.6 +/- 12.1 days vs 7.7 +/- 6.2 days, p less than 0.01). Significantly more of the team patients attained 1.2 X basal energy expenditure (BEE) (37 vs 26, p less than 0.05). Total number of abnormalities in each group was similar (T = 398, NT = 390); however, the abnormalities per day were significantly lower in the team group (T = 0.63 vs NT = 0.98, p less than 0.01). Mechanical (T = 0.05 vs NT = 0.11, p less than 0.01), gastrointestinal (T = 0.99 vs NT = 0.14, p less than 0.05), and metabolic (T = 0.49 vs NT = 0.72, p less than 0.01) abnormalities per day all were significantly lower in the team-managed patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutritional considerations in children undergoing bone marrow transplantation

“…Their responsibilities are shown in Table 3. The presence of a multidisciplinary nutritional care team in regional hospitals can improve the quality of the nutritional support and also reduce the cost (Brown et al 1987;Puntis & Booth 1990). Reported advantages of a nutritional care team include a reduction of central venous catheter sepsis and mechanical catheter-related problems, a decrease in metabolic complications associated with PN, and an increased use of enteral in place of parenteral nutrition (Hamaoui, 1987).…”

Structure and organisation of 47 nutrition support teams in Germany: a prospective investigation in 2000 German hospitals in 1999

“…(Mughal & Irving, 1986;Brown et al, 1987;Payne-James et al, 1990;Howard et al, 1991;Cohen, 1993;Hassel et al, 1994;Sousa, 1994;Elia, 1993). The spatial distribution of the NST in Germany showed a clear West-East slope.…”

“…The education of ward and medical staff to detect malnutrition should become a part of the work of the NST in the future. Nutrition visits on the wards, which are established in the USA, are not made in Germany (Brown et al, 1987;Regenstein, 1991;Roberts & Levine, 1992).…”

“…Individual NSTs have been shown to cover their own operating costs and in many cases have demonstrated savings in therapy costs (Roberts & Levine, 1992;Hassel et al, 1994;Ashley and Howard, 2000;Howard, 2001a,b). Although the advantages of NST in various disciplines inhospital as well as in the out-patient field could be demonstrated for the USA and a few European countries (Mughal & Irving, 1986;Brown et al, 1987;Payne-James et al, 1990;Howard et al, 1991;Cohen, 1993;Elia, 1993;Hassel et al, 1994;Sousa, 1994;Howard et al, 1997;Ashley & Howard, 2000;Allison, 2001), but very little is known on the structure and function of NST in Germany (Suchner et al, 2000). Among others, this must be because of the lack of acceptance of nutritional medicine in Germany (general lack of specialty, or subspecialty or curriculum) and also because of the lack of specifications for a standardisation of clinical nutrition by the patronage organisations, for example, DEGEM (Suchner et al, 2000).…”

Invited Review: Nutrition Support Teams: Past, Present, and Future

“…Even while the debate continued as to whether nutrition assessment and support had been proved valuable in reducing morbidity and mortality, 11-14 numerous articles appeared describing the structure, activities, and benefits of nutrition support teams. [15][16][17][18][19] surprisingly, the types of nutrition support teams and the scope of services provided vary greatly. The present review will concentrate on the structure and function of nutrition support teams, the clinical problems they seek to redress, the means by which the success of nutrition support teams are measured, and what nutrition support teams must do to survive and thrive in the future.…”