Long-Term Reduction in the Cost of Nutritional Intervention Achieved by a Nutrition Support Service

Abstract

Background: Short-term effectiveness of Nutrition Support Services (NSS) has been previously evaluated. However, long-term clinical and economic impact is unknown. This study tests the hypothesis that the NSS improves patient care while reducing costs and that the service should be maintained on a long-term basis. Methods: Prospective monitoring of the effectiveness of nutrition support was done during the whole length of the study. Parameters studied included: (1) use of the appropriate route of nutritional delivery; (2) physician compliance with the recommendations given by the NSS; (3) Monitoring of total parenteral nutrition (TPN) waste; and (4) evaluation of costs. Results: A dramatic change in the route of delivery of nutrients occurred when NSS was instituted. This coincided with increased physician awareness that an enteral route for nutrient delivery could be safely obtained in most patients thus avoiding an indiscriminate use of TPN. The initial trend in reduction of TPN observed in the first year (46% reduction in TPN in one year, p < .001) of the institution of the NSS has continued through the years (78.6% reduction in the use of TPN by 1999, p < .001). The use of enteral nutrition (EN) increased proportionately. A reduction in TPN waste from 493 bags in 1991 to 34 bags in 1999 was also observed. Compliance with recommendations forwarded by the NSS is now above 90% compared with 50% in 1991. TPN cost in 1991 was $513,246.00, which was reduced to $195,176.00 by 1999. We believe that significant savings in the cost of nutrition support have occurred as a result of the implementation of a NSS. Conclusions: Long-term maintenance of an NSS is warranted. The NSS provides constant surveillance and interventions regarding the appropriate nutrition support route, the adequacy of its use, and continuously minimizes waste.