Kennedy John F, Nightingale Jeremy M D
Leicester Royal Infirmary, UK.
Nutrition. 2005 Nov-Dec;21(11-12):1127-33. doi: 10.1016/j.nut.2005.08.002.
A hospital-based nutrition support team (NST) may need to demonstrate cost savings and quality benefits. The primary aim of this study was to determine whether an NST could show tangible cost savings (equipment, investigations, and medication costs) from managing patients considered for parenteral nutrition (PN). Secondary aims related to the quality issues of placement of PN catheters, catheter-related sepsis (CRS), duration of parenteral nutrition, and mortality.
An NST was formed in 1999 and worked in all adult areas of a university hospital (Leicester Royal Infirmary). Comparative data about all patients given PN were collected for 2 consecutive years (a retrospective pre-NST year and a prospective NST year).
In the pre-NST year there were 82 PN episodes (54 patients), 665 PN days, and a CRS rate of 71% (seven infections/100 PN days). In the NST year, there were 133 referrals for PN but only 78 PN episodes (75 patients, 59% of referrals), 752 PN days, and a decreased overall CRS rate of 29% (three infections/100 PN days, P < 0.05) but a rate of 7% (0.6 infection/100 PN days) in the final 3 mo of the NST year. Tangible cost savings for the NST year were derived from 55 avoided PN episodes (42741 pounds sterlings) and 35 avoided CRS episodes (7974 pounds sterlings). Thirty-nine percent of PN catheters were inserted by the NST with no insertion-related complications. Competency-based training of ward nursing staff decreased the CRS rate. Mean duration of PN increased from 8 to 10 d (P not significant). In-hospital mortality for patients who had PN was 23 of 54 (43%) in the pre-NST year compared with 18 of 75 (24%) in the NST year (P < 0.05).
Although the number of PN days increased with an NST, tangible cost savings of 50715 pounds sterlings were demonstrated within the NST year by avoided PN episodes and a decreased incidence of CRS. These savings justify the salaries of a nutrition nurse specialist and a senior dietitian.
基于医院的营养支持团队（NST）可能需要证明成本节约和质量效益。本研究的主要目的是确定NST能否通过管理考虑接受肠外营养（PN）的患者显示出切实的成本节约（设备、检查和药物成本）。次要目的涉及PN导管放置的质量问题、导管相关败血症（CRS）、肠外营养持续时间和死亡率。
1999年组建了一个NST，在一家大学医院（莱斯特皇家医院）的所有成人科室开展工作。连续两年收集了所有接受PN治疗患者的比较数据（NST成立前的回顾性年份和NST成立后的前瞻性年份）。
在NST成立前的年份，有82例PN治疗事件（54名患者），665个PN治疗日，CRS发生率为71%（每100个PN治疗日发生7例感染）。在NST成立后的年份，有133例PN转诊，但只有78例PN治疗事件（75名患者，占转诊患者的59%），752个PN治疗日，总体CRS发生率降至29%（每100个PN治疗日发生3例感染，P<0.05），但在NST成立后年份的最后3个月发生率为7%（每100个PN治疗日发生0.6例感染）。NST成立后年份切实的成本节约来自55例避免发生的PN治疗事件（42741英镑）和35例避免发生的CRS事件（7974英镑）。39% 的PN导管由NST插入，无插入相关并发症。对病房护理人员进行基于能力的培训降低了CRS发生率。PN平均持续时间从8天增加到10天（P无统计学意义）。接受PN治疗患者的住院死亡率在NST成立前年份为54例中的23例（43%），而在NST成立后年份为75例中的18例（24%）（P<0.05）。
尽管NST成立后PN治疗日数有所增加，但通过避免PN治疗事件和降低CRS发生率，在NST成立后的年份证明切实节约了50715英镑的成本。这些节约证明了营养护士专家和高级营养师的薪水是合理的。
