Nutrition support refers to any treatment that includes oral nutritional supplements, enteral tube feeding and parenteral (intravenous) nutrition that prevents complications, provides clinical and functional advantages and lowers costs. When used effectively, nutritional support can prevent complications while producing clinical and functional gains as well as saving costs.
An increasing number of individuals living with critical illnesses require nutrition support. Thanks to advances in techniques, equipment, formulations and access devices for this therapy, its availability has significantly increased.
What Is It?
Nutritional support involves administering nonvoluntary nutrients through tubes into either the gastrointestinal tract or bloodstream directly via peripheral and central venous access routes (peripheral and total parenteral nutrition, respectively). With improvements in enteral nutritional formulas, equipment, gastrointestinal access devices and total parenteral nutrition devices becoming more widely available than ever, nutritional support has become available to more individuals than ever before.
Nutrition support has been demonstrated as beneficial in specific patient populations, including severely malnourished surgical patients and those at risk of protracted semistarvation due to inadequacies in gastrointestinal length or function, severe oropharyngeal dysfunction or permanent neurological impairment. Evidence for clinical benefit within medical inpatient settings remains less evident.
Nutritional support helps individuals increase caloric and protein intake and body weight, prevent complications from undernutrition, manage glycemic levels more effectively, promote wound healing faster and preserve cognitive functioning – essential components of healthcare services in many settings. Nutritional assistance is provided by teams consisting of dietitians, nurses and physicians.
How Is It Helped?
Nutrition support therapy involves administering enteral or parenteral nutrition therapy through enteral tubes placed directly into the gastrointestinal tract or through peripheral or central venous access devices, respectively. Advancements in feeding techniques, equipment, nutrition formulations and access devices have allowed many more individuals to benefit from these interventions.
The effectiveness of PN therapy has been evaluated in numerous randomized clinical trials and meta-analyses, and results support its use among certain populations, such as severely malnourished individuals with chronic illness who require surgery or who have difficulty eating for extended periods pre and post operatively.
Family physicians should assess individuals receiving EN or PN feedings for compliance with their feeding regimen, signs and symptoms of dehydration and volume overload, complications with their tube feeding system (e.g. nasal erosion/occlusion) as well as biochemical abnormalities like hypokalemia or hyperglycemia. A multidisciplinary team approach should include registered dieticians and pharmacists on board as necessary.
Why Is It Helped?
Nutritional support can be important for many reasons. This includes minimizing inappropriate resource usage, increasing revenue streams, and improving patient outcomes such as shorter length of hospital stays, reduced infections, and non-elective readmissions.
Patients unable to eat or digest food require nutrition support due to chronic illnesses, adverse drug reactions or surgical procedures that prevent food intake. Without such support they risk malnutrition, repeated complications of semistarvation and even death.
Though data quality remains variable, evidence exists of how PN or EN improves outcomes. One study with 136 elderly medical inpatients who received nutrition support had significantly shorter lengths of hospital stays compared with controls while personnel savings due to shorter hospital stays contributed towards reduced personnel costs (Hassell et al, 1994). Other studies have demonstrated how nutrition support helps reduce rates of recurrent infections while decreasing nonelective readmission frequency while increasing daily caloric and protein intake as well as body weight gains.
What Is It Costing?
Cost of nutrition support depends on factors like insurance coverage, credentials of an RDN and where they reside; it also can depend on how often appointments will be scheduled each month.
RDNs typically charge $100-250 an hour or $500-2,000 for comprehensive coaching packages. You should select an RDN whose fees fit within your budget while their coaching style aligns with both your personality and nutritional goals.
Retrospective study of patients receiving enteral and parenteral nutrition support revealed that team models yielded significantly lower costs than non-team models (Hassell et al., 1986). This result was attributable to the efficient performance of patient assessments and implementations therapy sessions, monitoring response to therapy, education, quality assurance and overall cost reduction due to reduced length of stay (which offset salary costs for nutrition support team personnel) thus yielding an estimated net benefit of $4.20 for every dollar invested into nutrition support teams.
