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Study 4 Citation: Sceery NL Managing Nutrition Support In The Home: Integrating Hospital And Home Care Services Support
Line 2002;24(6):9-16 |
Click on the link at left to go to your desired page: Introduction Page 2 Study 1 Study 2 Study 3 Study 4 Conclusion Post-Test
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Abstract:
As hospital stays continue to decrease there is a greater emphasis on outpatient and home care services. In the case of home parenteral and enteral nutrition (HPEN) support, the challenge of transferring patients to the home care setting is one of communication that crosses lines of settings and service providers such as: hospital, rehabilitation facility, home medical equipment (HME) companies, homecare companies, and other agencies. This review discusses the integration of hospital and home nutrition support services to meet the complex and labor-intensive needs of HPEN patients while maximizing cost-effectiveness by reducing duplicated efforts and improving communications.
homecare, parenteral nutrition, enteral nutrition, patient management, cost savings, nutrition assessment, transition
Discussion:
Selected reports suggest that 50% or more of patients in both hospital and homecare may experience malnutrition. Appropriate solutions for malnutrition have become an important part of cost-effective patient management to prevent and resolve malnutrition-related complications and the adverse effects on clinical and other outcomes. More complex skill sets and communications are required while financial resources are demanding more streamlined methods to successfully maintain a patient on HPEN. Even so, for patients who are candidates, transition to HPEN is generally considered a cost-effective alternative to nutrition support provided in an institutional setting. It has been suggested that the provision of “high quality nutritional care” could yield a cost savings of over $1000 per patient. However, the author notes, this savings can quickly disappear with the lack of communication and duplication of efforts by hospital and homecare personnel.
Communication becomes a particular challenge when transitioning a patient from a hospital setting to homecare as the lack of resources has forced the disbandment of many nutrition support teams that would normally shoulder this responsibility. To accomplish this communication flow, the author suggests the following flow:
As the patient is discharged from the hospital with referral for HPEN the hospital-based pharmacists, nurses, dietitians, and case managers can communicate assessments, goals, and recommendations directly to the homecare setting in concert with physician communication. Direct communication would reduce the duplication of assessments, care planning, and recommendations.
Standardization of forms in cooperation between settings is another method to improve cost-effective services. Another suggestion is a nutrition support team or nutrition support tools that transcend the hospital boundaries and provides services in both hospital and home settings may be able to increase productivity. Shared paperwork may include screening forms, assessment forms, trending forms, referral forms that include all communication contact information, and standard Medicare criteria forms that can document the hospitalized patient course for transition to homecare at discharge.