Effect of nutritional support team restructuring on the use of parenteral nutrition.
OBJECTIVE
The inappropriate use of parenteral nutrition (PN) continues to be a problem, despite several decades of efforts to improve the situation. We restructured our existing nutritional support team employing methods involving the institution's systems and individual physician interaction and education. Our aim was to study the effects of these changes on the use of PN in our institution.


METHODS
Records of all non-critically ill patients seen by our nutritional support team for PN during 2003-2004 (phase I, before restructuring) and 2005-2006 (phase II) were reviewed. Patients were classified under "appropriate," "inappropriate," and "marginal" categories based on published guidelines. During phase II, a new committee was formed, policies and procedures were updated, educational activities were increased, emphasis was placed on evidence-based guidelines, and periodic bedside rounds with the team physicians were initiated. Communication with referring physicians was improved.


RESULTS
Three hundred three of 335 patients in phase I and 271 of 333 patients in phase II were eligible for inclusion in analysis. Appropriate PN increased from 71.3% to 83.4%; inappropriate PN decreased from 16.5% to 8.9% (P = 0.002).


CONCLUSIONS
Restructuring of the nutritional support team improved the proper utilization of PN and decreased inappropriate use of PN in a public teaching hospital.
Sriram
Krishnan
K
Division of Surgical Critical Care, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA. ksriram41@hotmail.com
Cyriac
Tissy
T
Fogg
Louis F
LF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000706:statistics & numerical data*; D005791:Patient Care / Q000592:standards*; D010348:Patient Care Team / Q000458:organization & administration*; D055815:Young Adult