The Financial Impact of Patients With Prolonged Npo Status on a Community Hospital

Abstract

LEARNING OUTCOME: To examine the financial impact of prolonged NPO status in surgical patients.Decreasing length of stay (LOS) and cost containment are two major objectives of health care reform. Poor nutritional status prior to surgery and prolonged NPO status after surgery can increase LOS and thus, hospital costs. Fifty patients admitted for bowel surgery were studied from June to December, 1995. Of these patients, only 5 (10%) had a scrum albumin level drawn prior to surgery. History of weight loss (10% in 6 months or 5% in 3 months) was used to identify patients at nutritional risk. Eleven patients (22%) had sufficient information to be assessed at nutritional risk prior to their surgery. Of these 11 patients, 8 (72.7%) had an actual LOS greater then the Allowed LOS per Medicare DRG, and 2 patients (18.2%) who had been discharged within their allowed LOS were readmitted within 3 days Therefore, 10 of the 11 patients (90.9%) assessed at nutritional risk had extended LOS.An ongoing study of Cost Containment through Nutrition Intervention by the Clintcc Nutrition Company notes that 1 hospital day is saved for every 2 days of earlier nutrition intervention. Applying these figures to the patient in the study kept NPO for greater than 7 days, a minimum of 23 hospital days could have been saved if the patient had been fed two days earlier. If these same patients had received adequate nutrition four days sooner, the hospital could have saved as much as $32,154. Based on a daily average cost of $699 for a non-lCU bed. The study demonstrates that significant financial savings can be realized by more aggressive identification of patients at nutritional risk prior to surgery and earlier nutrition intervention after surgery.