M Goldstein1, L E Braitman, G M Levine. 1. Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA.
Abstract
BACKGROUND: Cost-containment pressures have adversely affected hospital nutrition support team staffing. We determined the effect of termination of a nutrition support nurse responsible for patients receiving total parenteral nutrition (TPN) on quality assurance and financial indicators. METHODS: A retrospective review of all 1,093 patients receiving TPN from fiscal year (FY) 1992 through FY 1998 in a tertiary care community hospital. We documented the changes in care during years when the nutrition support nurse position was staffed, terminated, and restored. Indicators studied included inappropriate TPN, central venous line sepsis, TPN wastage, and estimates of preventable costs. RESULTS: When the nurse was present, 8.6% of TPN patients had a functional gastrointestinal (GI) tract and inappropriately received TPN compared with 12.1% when the nurse was absent, a risk difference of 3.5% points (95% confidence interval [CI], -.06 to 8.3; p = .069). Risk of TPN-associated line sepsis increased from 8.8% of patients when the nurse was present to 13.2% when the nurse was absent, a difference of 4.4% points (95% CI, 0.06 to 9.2; p = .028). In the absence of the nurse, 26.3% of TPN patients had preventable charges vs 17.5% when the nurse was present (p < .0001). Total preventable charges were higher in the years without a nurse (p < .003). Total preventable costs increased by $38,148 to $194,285 (depending on the estimate for sepsis) in the year after termination. Reinstatement of the nurse resulted in a decrease in costs between $34,485 and $156,654. CONCLUSIONS: Adequate staffing of a nutrition support team reduced inappropriate TPN and complications of TPN. Financial savings of the same order of magnitude as the nurse's compensation accompany substantial decreases in patient morbidity.
BACKGROUND: Cost-containment pressures have adversely affected hospital nutrition support team staffing. We determined the effect of termination of a nutrition support nurse responsible for patients receiving total parenteral nutrition (TPN) on quality assurance and financial indicators. METHODS: A retrospective review of all 1,093 patients receiving TPN from fiscal year (FY) 1992 through FY 1998 in a tertiary care community hospital. We documented the changes in care during years when the nutrition support nurse position was staffed, terminated, and restored. Indicators studied included inappropriate TPN, central venous line sepsis, TPN wastage, and estimates of preventable costs. RESULTS: When the nurse was present, 8.6% of TPN patients had a functional gastrointestinal (GI) tract and inappropriately received TPN compared with 12.1% when the nurse was absent, a risk difference of 3.5% points (95% confidence interval [CI], -.06 to 8.3; p = .069). Risk of TPN-associated line sepsis increased from 8.8% of patients when the nurse was present to 13.2% when the nurse was absent, a difference of 4.4% points (95% CI, 0.06 to 9.2; p = .028). In the absence of the nurse, 26.3% of TPN patients had preventable charges vs 17.5% when the nurse was present (p < .0001). Total preventable charges were higher in the years without a nurse (p < .003). Total preventable costs increased by $38,148 to $194,285 (depending on the estimate for sepsis) in the year after termination. Reinstatement of the nurse resulted in a decrease in costs between $34,485 and $156,654. CONCLUSIONS: Adequate staffing of a nutrition support team reduced inappropriate TPN and complications of TPN. Financial savings of the same order of magnitude as the nurse's compensation accompany substantial decreases in patient morbidity.
Authors: Wellington Andraus; Rafael Soares Pinheiro; Allana Christina Fortunato; Flavio Henrique Ferreira Galvão; Rubens Macedo Arantes Junior; Daniel Reis Waisberg; Andre Dong Lee; Mariana Hollanda Martins da Rocha; Lucas Souto Nacif; Vinicius Rocha Santos; Liliana Ducatti; Rodrigo Bronze de Martino; Luciana Bertocco de Paiva Haddad; Ryan Yukimatsu Tanigawa; Regis O F Bezerra; Alice Tung Wan Song; Luiz Augusto Carneiro-D'Albuquerque Journal: Clinics (Sao Paulo) Date: 2021-10-29 Impact factor: 2.365