Metabolic and monetary casts of avoidable parenteral nutrition use

Background: We prospectively collected data on in patients receiving parent eral nutrition to determine the magnitude of potentially preventable metabo lic and monetary costs associated with parenteral nutrition. Methods: Paren teral nutrition was prescribed by the treating physicians with optional con sultation from a multidisciplinary metabolic support service. Days on paren teral nutrition, appropriateness of parenteral nutrition, metabolic complic ations, and avoidable parenteral nutrition charges were determined. Parente ral nutrition use was considered "indicated" or "not indicated" based on th e American Society for Parenteral and Enteral Nutrition guidelines and "pre ventable" if the gastrointestinal tract was functional but not accessed whe n possible. Results: Of the 209 parenteral nutrition starts, 62% were indic ated, 23% were preventable, and 15% were not indicated. Parenteral nutritio n starts were deemed indicated in 82% of instances in which a metabolic sup port service consult was obtained, compared with 56% in which a consultatio n was not obtained (p = .004). Hyperglycemia was the most common metabolic complication, with an overall incidence of 20%. Metabolic complications occ urred less frequently in patients who received a metabolic support service consultation compared with patients who did not (34% vs 66% of parenteral n utrition days, respectively; p = .004). Parenteral nutrition use of less th an or equal to 5 days duration was significantly less frequent among patien ts who received metabolic support service consultation (16% vs 35%; p = .00 2). Parenteral nutrition that was not indicated or preventable resulted in excess annualized patient charges of more than one half million dollars not accounting for charges related to treatment of potentially avoidable paren teral nutrition complications. Conclusions: This study illustrates that not -indicated and preventable parenteral nutrition initiation, short-term pare nteral nutrition use, and metabolic complications are less likely when pati ents receive consultation by a multidisciplinary team with expertise in nut rition and metabolic support. Furthermore, the avoidance of inappropriate p arenteral nutrition use translates into substantial cost savings.