Nutritional support teams: a review of comparative trials.
OBJECTIVE
To evaluate the literature describing the influence of nutritional support teams (NSTs) on the provision of nutritional therapy.


METHODS
A MEDLINE and International Pharmaceutical Abstracts search (key terms: nutritional support, nutritional support service/team, hyperalimentation service/team, metabolic support service/team, service/team) covering 1970-1993 were used to identify pertinent literature.


METHODS
The results of comparative trials involving NSTs are presented.


METHODS
Data from comparative trials examining the influence of NSTs on the provision of enteral nutrition (EN) and total parenteral nutrition are discussed.


RESULTS
NSTs dramatically reduced the incidence of catheter-related complications, especially sepsis, by developing central venous catheter insertion and care guidelines. Early studies found that NSTs reduced the incidence of electrolyte and metabolic abnormalities by more stringent laboratory and clinical monitoring, but this was not found consistently in later studies. The ability of consultative NSTs to reduce the incidence of metabolic and electrolyte abnormalities is less clear. NSTs also were more likely to evaluate, document, and subsequently meet a patient's nutritional requirements. Studies examining the financial impact of NSTs frequently reported cost savings, but often failed to include personnel costs in their analysis. The provision of EN by an NST reduced the frequency of complications and increased the adequacy of nutritional supplementation.


CONCLUSIONS
Early nutritional support teams produced significant benefits largely through the development of protocols and standardization. Current NSTs should increase the dissemination of information supporting their continued benefits. To remain viable, NSTs need to expand their roles, document improved patient outcomes, and show cost-effectiveness.
Gales
B J
BJ
Department of Pharmacy Practice, School of Pharmacy, Southwestern Oklahoma State University, Weatherford.
Gales
M J
MJ
D002405:Catheterization, Central Venous / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D004573:Electrolytes / Q000378:metabolism; D004750:Enteral Nutrition / Q000191:economics / Q000592:standards*; D006801:Humans; D008659:Metabolic Diseases / Q000209:etiology; D010289:Parenteral Nutrition, Total / Q000191:economics / Q000592:standards*; D010348:Patient Care Team / Q000191:economics
D004573:Electrolytes