The medical and financial costs associated with termination of a nutritionsupport nurse

Background: Cost-containment pressures have adversely affected hospital nut rition support team staffing. We determined the effect of termination of a nutrition support nurse responsible for patients receiving total parenteral nutrition (TPN) on quality assurance and financial indicators. Methods: A retrospective review of all 1,093 patients receiving TPN from fiscal year ( FY) 1992 through FY 1998 in a tertiary care community hospital. We document ed the changes in care during years when the nutrition support nurse positi on was staffed, terminated, and restored. Indicators studied included inapp ropriate TPN, central venous line sepsis, TPN wastage, and estimates of pre ventable costs. Results: When the nurse was present, 8.6% of TPN patients h ad a functional gastrointestinal (GI) tract and inappropriately received TP N compared with 12.1% when the nurse was absent, a risk difference of 3.5% points (95% confidence interval [CI], -.06 to 8.3; p = .069). Risk of TPN-a ssociated line sepsis increased from 8.8% of patients when the nurse was pr esent to 13.2% when the nurse was absent, a difference of 4.4% points (95% CI, 0.06 to 9.2; p = .028). In the absence of the nurse, 26.3% of TPN patie nts had preventable charges vs 17.5% when the nurse was present (p < .0001) . Total preventable chargee were higher in the years without a nurse (p < . 003). Total preventable costs increased by $38,148 to $194,285 (depending o n the estimate for sepsis) in the year after termination. Reinstatement of the nurse resulted in a decrease in costs between $34,485 and $156,654. Con clusions: Adequate staffing of a nutrition support team reduced inappropria te TPN and complications of TPN. Financial savings of the same order of mag nitude as the nurse's compensation accompany substantial decreases in patie nt morbidity.