title: Effectiveness of a clinical practice guideline for parenteral nutrition: a 5-year follow-up study in a pediatric teaching hospital.
abstract: OBJECTIVE
  To determine the effectiveness of a clinical practice guideline (CPG) on the use of parenteral nutrition (PN) at a tertiary care pediatric hospital.
  
  
  METHODS
  Review of prospectively collected data on hospital-wide PN use 2 years before and 5 years after the establishment of the CPG. Effectiveness of the CPG was measured as the percentage of PN courses lasting fewer than 5 days and the number of PN starts per 1000 patient days.
  
  
  RESULTS
  During the study period, 5745 PN courses were administered. The mean (SD) number of PN starts per 1000 inpatient days was 8.86 (0.78) before the CPG and 9.54 (2.49) afterwards (p = .28). The percentage courses of PN lasting for fewer than 5 days declined from 26.3% before the CPG to 18.4% afterwards (p < .0001). A multivariate model confirmed that the rate of short-term PN starts declined after the CPG was issued. The mean (SD) number of PN courses shorter than 5 days in the 2 years before the CPG was 2.33 (0.42) per 1000 patient days versus 1.75 (0.45) in the 5 years after the CPG was instituted (p = .005), which is a 25% decline. The services with the highest volume of PN use showed the most significant decreases in short-term PN use. A cost savings to the hospital of more than $50,000 may have been realized.
  
  
  CONCLUSIONS
  In a large pediatric tertiary care hospital, a CPG was successfully deployed. CPGs can favorably affect the use rates and costs of parenteral nutrition.
authors.affiliation: Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts 02115, USA. christopher.duggan@tch.harvard.edu
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.forename: Camielle
authors.initials: C
authors.lastname: Rizzo
authors.forename: Andrew
authors.initials: A
authors.lastname: Cooper
authors.forename: Susan
authors.initials: S
authors.lastname: Klavon
authors.forename: Vanessa
authors.initials: V
authors.lastname: Fuchs
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gura
authors.forename: Denise
authors.initials: D
authors.lastname: Richardson
authors.forename: Sharon
authors.initials: S
authors.lastname: Collier
authors.forename: Clifford
authors.initials: C
authors.lastname: Lo
mesh_terms: D000465:Algorithms; D002648:Child; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D016017:Odds Ratio; D010288:Parenteral Nutrition / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013997:Time Factors