NUTRITION SUPPORT TEAM MANAGEMENT OF ENTERALLY FED PATIENTS IN A COMMUNITY-HOSPITAL IS COST-BENEFICIAL

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.