Use of Practice Guidelines by Clinical Dietitians Impacts the Route of Nutrition Support Resulting in Cost Savings

Abstract The impact of intervention by clinical dietitians at a large teaching medical center was studied over a 3 year period. Current nutrition support guidelines recommend the use of enteral nutrition (EN) over parenteral nutrition (PN) therapy when the gut can be used. Dietitians influence the route of nutrition support at this medical center through patient assessment and recommendations, development of adult PN guidelines, and medical staff education including resident training. It was hypothesized that these efforts would result in a reduction in use of PN and increased use of EN. Data on indications/reasons for initiation of nutrition support were collected on TPN patients (excluding neonates) during February-March, 1997 and compared with established ASPEN criteria. Summary data on days of PN and EN and costs in 1995 and 1997 were obtained from pharmacy and relevant departments. In 87% of cases (45 of 52) in the focus review, PN therapy was determined to be appropriate. The most common reason for initiation of PN was an nonfunctional GI tract in catabolic or malnourished patients. Eighty-two per cent of patients (n=43) were malnourished at the time therapy was initiated. PN usage declined 33% from 1995 to 1997 (11,364 days to 7656 days) while EN usage increased 22% (9684 vs. 11,832 days). Based on the total reduction in PN, cost savings in solutions alone total $217,000 annually. If only potential conversion of PN to EN is considered, cost savings total $116,000 annually. Estimated cost savings do not consider other associated costs including complications or initiation costs which are higher in PN patients. Intervention by clinical dietitians has resulted in appropriate nutrition support with a significant potential costs savings to the medical center.