title: Can home parenteral nutrition be provided by non-specialised centres? 2300 weeks of experience at a district general hospital in the United Kingdom.
abstract: OBJECTIVE
  Home Parenteral Nutrition (HPN) is an accepted treatment of intestinal failure but is mostly restricted to a few large specialist centres in the UK. The provision of high-quality HPN is of paramount importance to patients with intestinal failure, but its restriction to large specialist centres limits the number of patients who can receive it. The study aim was to determine if HPN can be effectively administered in a non-specialist centre.
  
  
  METHODS
  Adult HPN patients at a single District General Hospital in the United Kingdom were analysed by indications, complications and outcome.
  
  
  RESULTS
  2310 patient weeks of HPN were provided to 23 patients, aged 18-80 years with intestinal failure. Catheter infection rate was 0.315 per patient year, with one patient excluded due to persistent nasal digitation. Patients spent 89.96% of their time at home and 82.6% achieved a Karnowsky Index of 70 (generally self-caring or greater).
  
  
  CONCLUSIONS
  HPN can be practised at non-specialist District General Hospital level achieving complication rates comparable to large specialist centres, and this lends weight to the argument for a network model to widen provision beyond large tertiary referral specialist centres in the United Kingdom.
authors.affiliation: Department of Gastroenterology and Nutrition, Russells Hall Hospital, Dudley DY1 2HQ, West Midlands, UK. d.a.freshwater@bham.ac.uk
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Freshwater
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Saadeddin
authors.forename: Penny
authors.initials: P
authors.lastname: Deel-Smith
authors.forename: Tim
authors.initials: T
authors.lastname: Digger
authors.forename: Barry J M
authors.initials: BJ
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007410:Intestinal Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D011787:Quality of Health Care; D018805:Sepsis / Q000453:epidemiology* / Q000517:prevention & control; D016896:Treatment Outcome; D006113:United Kingdom