Digest This - Special Edition 2008 - (Page 16)

cleveland clinic cost savings Resulting From early tube Feeding Results from studies about the timing of enteral nutrition and the effect of health indices of intensive care unit (ICU) patients have been contradictory. Cleveland Clinic Dietitian Anne Christine Hummell, MS, RD, LD, recently led a study published in the Journal of the American Dietetic Association comparing the cost, length of stay and discharge placement of intubated patients in a medical intensive care unit (MIC) based on the timing of tube feeding initiation. The study compared the length of stay (LoS), hospital and dietitian (RD) costs, and discharge placement of intubated patients started on tube feeding within 24 Patients tube fed between 24 and 48 hours had an ICU and hospital LoS of 15.0 and 26.5 days respectively, with an average hospital cost of $32,544 and RD charge of $215. Forty-four percent were discharged to a SnF, 21 percent to home and 36 percent to other facilities. Patients tube fed after 48 hours had an ICU and hospital LoS of 14.1 and 24.9 days respectively, with an average hospital cost of $28,225 and RD charge of $229. Thirtythree percent were discharged to a SnF, 21 percent to home and 46 percent to other facilities. Based on chi-square analysis, initiating enteral nutrition within 24 hours of ICU admission resulted in the shortest ICU (p = 0.01) and hospital LoS (p = 0.01) as well as the lowest hospital cost (p = 0.01) and RD cost (p = 0.05). This group also had the highest percentage of patients discharged home (p = 0.01). “Based on this study, MIC changed its procedures to promote enteral nutrition within the first 24 hours of admission to the unit. Studies like this can help us provide better care of our patients.” hours of admission to MIC with those started later. Patients who expired while hospitalized or had multiple ICU admissions were excluded. of the 143 patients (average age 60.6 years, 75 female, 68 male), 65 were tube fed within 24 hours, 39 were tube fed between 24 and 48 hours, and 39 were tube fed after 48 hours of MIC admission. Thirty-one percent of the subjects had pneumonia, 41 percent other pulmonary disorders and 29 percent other diagnoses. Patients tube fed within 24 hours had an ICU and hospital LoS of 8.7 and 18 days respectively, with an average hospital cost of $19,621 and RD charge of $182. Twenty-nine percent were discharged to a skilled nursing facility (SnF), 28 percent to home and 43 percent to other facilities. There seemed to be no difference for patients’ LoS, cost or discharge placement when tube feedings were started after 24 hours as compared to those started after 48 hours, Hummell says. “Based on this study, MIC changed its procedures to promote enteral nutrition within the first 24 hours of admission to the unit,” she says. “Studies like this can help us provide better care of our patients.” For more information, email digestthis@ccf.org {16} Digest This Special Edition | 2008

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Digest This - Special Edition 2008 Table of Contents Investigations Institute Overview Innovations Staff Research

Digest This - Special Edition 2008

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