State of Nutrition Support Teams

Abstract

The incidence of malnutrition in hospitalized patients is relatively high (up to 55%) despite breakthroughs in nutrition support therapies. These patients have increased morbidity and mortality, extended hospital stays, and care that is associated with higher costs. These patients are often poorly managed due to inadequate nutrition assessment and poor medical knowledge and practice in the field of nutrition. Nutrition support teams (NSTs) are interdisciplinary support teams with specialty training in nutrition that are often comprised of physicians, dietitians, nurses, and pharmacists. Their role includes nutrition assessment, determination of nutrition needs, recommendations for appropriate nutrition therapy, and management of nutrition support therapy. Studies have demonstrated significant improvements in patient nutrition status and improved clinical outcomes as well as reductions in costs when patients were appropriately managed by a multispecialty NST vs individual caregivers. Despite this, there has been steady decline in the number of formal NST in recent years (65% of hospitals in 1995 to 42% in 2008) as hospitals and other healthcare organizations look for ways to cut costs. Given the importance of nutrition status on clinical outcomes and overall healthcare costs, a number of institutions have introduced and sustained strong nutrition training and support programs and teams, demonstrating both clinical and economic benefit. The benefits of NST, training and implementation strategies, and tips for justifying these clinically and economically beneficial groups to healthcare organizations and governing bodies are discussed in this review.

Impact and Outcomes of Nutritional Support Team Intervention in Patients with Gastrointestinal Disease in the Intensive Care Unit

“…[20,21] Unlike this misconception with formal NSTs causing increased costs with minimal benefits, many studies [22,23] actually showed that when a proper management is done by an NST, there are significant improvements in the nutritional status of patients and in clinical outcomes, and it even leads to reductions in the expenses for hospitals. [14] Based on these findings, NST intervention for critically ill patients with GI disease would be expected to reduce mortality and morbidity. Martin et al [24] performed a multicenter, cluster-randomized clinical trial that compared characteristics between patients from 7 control hospitals (n = 214) and 7 nutrition intervention hospitals (n = 248).…”

“…[19] Several studies have shown favorable effects of NS for patients who are at nutritional risk within the ICU. [6,7] According to the systemic review from DeLegge and Kelley, [14] many hospitals and other organizations in the healthcare field have been gradually reducing the number of NSTs lately even with their proven efficacy through literature, because they try to find ways to lower expenses. According to the 2008 survey by the American Society for Parenteral and Enteral Nutrition (ASPEN), only 42% of the respondents, who practice in a hospital setting, reported that they had official NSTs.…”

“…We strictly followed the protocols and applied them to the patients. [13,14] 2.4. Nutritional risk screening 2.4.1.…”

Premixed Multichamber Bags Versus Compounded Parenteral Nutrition (Cost Debate)

“…26 Aynı şekilde daha önce yapılan çalışmalarda hastaya özel PN desteği sağlayan KNÜ'nün bulunduğu multidisipliner merkezlerde, PN'nin etkinlik, gü-venirlilik ve kalitesinde kayda değer bir artışla beraber, malnütrisyon hastalarının hastanede kalış süresi, morbidite ve mortalite oranlarını düşürdüğü bildirilmektedir. [27][28][29][30][31][32][33] Yine, yapılan çalışmalarda BDE'lerin sıkı laboratuvar ve klinik monitorizasyona bağlı olarak elektrolit dengesizlikleri gibi metabolik komplikasyonları önemli ölçüde azalttığı, sepsis, pnömotoraks gibi kateterle ilişkili komplikasyonların, nütrisyon konusunda eğitimli bir takım ve/veya tecrübeli hekimlerle azalabilmekte olduğu ve klinik bakımın kalitesini artırarak maliyeti azalttığı; nütrisyon takımının önerilerinin mali avantajlar sağlayabileceği bildirilmiştir 4,5,[34][35][36][37][38][39] Bununla beraber, compounder sisteminin uygulanabilmesi için aseptik ortam şartı ve dolum işleminde görevli eğitimli personel şartı vardır. 40,41 Dolayısıyla ideal sonuçlar için günlük parenteral beslenen hasta sayısı çok önemlidir.…”

Nutritional Support Team Intervention for Patients with Mandibular Fracture Treated by Intermaxillary Fixation

“…NSTs typically comprise physicians, dietitians, nurses, laboratory medical technologists and pharmacists [1]. NST intervention usually includes nutritional assessment, determination of nutritional requirements, recommendations for appropriate nutrition therapy and management of nutrition support therapy.…”