Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
JPEN J Parenter Enteral Nutr. 2011 Jan;35(1):122-30. doi: 10.1177/0148607110362992. Epub 2010 Oct 19.
Parenteral nutrition (PN) is an essential feeding route for specific patient populations. Despite its utility, PN is invasive, costly, and associated with clinical complications. In most U.S. hospitals, PN is overprescribed. This study measured rates of inappropriate PN use in hospitalized adults, as determined by the 2002 American Society for Parenteral and Enteral Nutrition guidelines, at 4 tertiary care South Carolina hospitals (facilities A-D). Secondary aims were to identify indicators of inappropriate use and estimated preventable costs.
Over a 3-month period, trained registered dietitians at each site collected data retrospectively and prospectively to determine PN appropriateness and indicators of use in 278 randomly selected PN cases.
PN therapy was inappropriately prescribed in 32% of cases, resulting in approximately 552 days and $138,000 in preventable hospital costs. Thirteen percent of patients who were prescribed inappropriate PN were discharged on home PN. Mean duration of PN therapy was higher in inappropriate cases vs appropriate cases (6 ± 7 days [range, 1-78 days] vs 10 ± 10.6 days [range, 1-51 days]; P < .004). Facility B had lower rates of inappropriately prescribed PN (23%) compared with facilities A (33%), C (35%), and D (38%). Dietitians recommended against PN in >70% of all inappropriate cases at facilities A and D compared with <45% at facilities B and D (P < .001). Facility B employed more certified nutrition support dietitians (68% of staff) and was among the 2 hospitals using a nutrition support team (NST).
This study was novel by comparing PN practices in statewide hospitals. Results indicate that NSTs and certified nutrition support clinicians can curtail preventable spending from inappropriate PN use. Future studies should identify barriers in implementing evidence-based practice.
肠外营养（PN）是特定患者群体的重要喂养途径。尽管它具有实用性，但 PN 是侵入性的、昂贵的，并且与临床并发症有关。在美国大多数医院，PN 被过度开具。这项研究在美国南卡罗来纳州的 4 家三级保健医院（A 至 D 设施），按照 2002 年美国肠外和肠内营养学会指南，测量了住院成人中不适当使用 PN 的发生率。次要目的是确定不适当使用的指标和估计可预防的费用。
在 3 个月的时间里，每个地点的经过培训的注册营养师回顾性和前瞻性地收集数据，以确定 278 例随机选择的 PN 病例的 PN 适宜性和使用指标。
32%的 PN 治疗方案被不当开具，导致约 552 天和 138000 美元的可预防住院费用。13%的开具不适当 PN 处方的患者出院后在家中接受 PN。不适当病例与适当病例的 PN 治疗时间中位数分别为 6 ± 7 天（范围，1-78 天）和 10 ± 10.6 天（范围，1-51 天）；P <.004）。与设施 A（33%）、C（35%）和 D（38%）相比，设施 B 的 PN 处方不当率较低（23%）。与设施 A 和 D 的所有不适当病例中 >70%的营养师建议不使用 PN 相比，设施 B 和 D 的这一比例 <45%（P <.001）。设施 B 雇用了更多的认证营养师（68%的员工），并且是使用营养支持团队（NST）的 2 家医院之一。
本研究通过比较全州医院的 PN 实践，具有创新性。结果表明，NST 和认证营养师可以减少不适当使用 PN 导致的可预防支出。未来的研究应确定实施基于证据的实践的障碍。
