Establishing a nutrition support team at a children's hospital in the current era of fixed reimbursement

Our goal was to evaluate the establishment of a formal Nutrition Support Team (NST) at our 156-bed tertiary-care Children's Hospital. The financial viability and cost effectiveness of NSTs continues to be of concern in today's health care environment where per diem reimbursement and capitation drive provision of services. We surveyed 13 comparable Children's Hospitals across the country to determine the current status of NSTs. The majority of the NSTs surveyed were using a portion of the parenteral nutrition (PN) solution charge to finance the team. This method, once the ideal model, is no longer practical with only limited dollars to spend on hospitalized patients, The survey responses prompted a multidisciplinary team from our hospital to visit and assess four of the top pediatric NST programs. Our site visits suggested another financial model - the establishment of a separate cost center for the NST. With this information and literature validation of NSTs, a business plan was developed which included a tabular summary of the survey and site visit results. The plan also outlined the goals, organization, personnel, and financial impact of our proposed NST. Our plan for improving patient care, while reducing hospital costs, convinced hospital administration to authorize a one-year pilot program to further document the benefits of a NST at our center. During our pilot study we will evaluate the effect of a formal NST on: length of stay; duration of PN therapy; appropriate utilization of laboratory tests; cost of care; errant PN orders; mechanical, septic and metabolic complications; and overall nutritional status of patients on PN.