Metabolic and Monetary Costs of Avoidable Parenteral Nutrition Use

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 23; no. 2; pp. 109 - 113
• Main Authors: Trujillo, Elaine B., Young, Lorraine S., Chertow, Glenn M., Randall, Sheldon, Clemons, Traci, Jacobs, Danny O., Robinson, Malcolm K.
• Format: Journal Article
• Language: English
• Published: Thousand Oaks, CA Sage Publications 01.03.1999; SAGE Publications; ASPEN; American Society for Parenteral and Enteral Nutrition
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cost Savings; Digestive System Physiological Phenomena; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Health Care Costs; Humans; Hyperglycemia - etiology; Hyperkalemia - etiology; Hypernatremia - etiology; Hypertriglyceridemia - etiology; Hypokalemia - etiology; Intensive care medicine; Magnesium Deficiency - etiology; Medical sciences; Parenteral Nutrition - adverse effects; Parenteral Nutrition - economics; Parenteral Nutrition - utilization; Prospective Studies; Human; Costs; Hospital consultation; Indication; Health economy; Complication; Epidemiology; Medical specialty; Parenteral administration; Feeding; Incidence
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/0148607199023002109

Background: We prospectively collected data on in patients receiving parenteral nutrition to determine the magnitude of potentially preventable metabolic and monetary costs associated with parenteral nutrition. Methods: Parenteral nutrition was prescribed by the treating physicians with optional consultation from a multidisciplinary metabolic support service. Days on parenteral nutrition, appropriateness of parenteral nutrition, metabolic complications, and avoidable parenteral nutrition charges were determined. Parenteral nutrition use was considered "indicated" or "not indicated" based on the American Society for Parenteral and Enteral Nutrition guidelines and "preventable" if the gastrointestinal tract was functional but not accessed when possible. Results: Of the 209 parenteral nutrition starts, 62% were indicated, 23% were preventable, and 15% were not indicated. Parenteral nutrition starts were deemed indicated in 82% of instances in which a metabolic support service consult was obtained, compared with 56% in which a consultation was not obtained (p = .004). Hyperglycemia was the most common metabolic complication, with an overall incidence of 20%. Metabolic complications occurred less frequently in patients who received a metabolic support service consultation compared with patients who did not (34% us 66% of parenteral nutrition days, respectively; p = .004). Parenteral nutrition use of s5 days duration was significantly less frequent among patients who received metabolic support service consultation (16% us 35%; p = .002). Parenteral nutrition that was not indicated or preventable resulted in excess annualized patient charges of more than one half million dollars not accounting for charges related to treatment of potentially avoidable parenteral nutrition complications. Conclusions: This study illustrates that not-indicated and preventable parenteral nutrition initiation, short-term parenteral nutrition use, and metabolic complications are less likely when patients receive consultation by a multidisciplinary team with expertise in nutrition and metabolic support. Furthermore, the avoidance of inappropriate parenteral nutrition use translates into substantial cost savings. (Journal of Parenteral and Enteral Nutrition 23:109-113, 1999)