Assessment of physicians' ability to prescribe parenteral nutrition support in a community teaching hospital.

Parenteral nutrition is the most costly mode of nutrition therapy (1,2). The diversity of didactic instruction and clinical experience during medical school and residency training in the area of nutrition support results in marked variability in knowledge and skill among physicians in regards to nutrition assessments and ordering parenteral nutrition (3,4). As a result of inconsistent knowledge, parenteral nutrition may be ordered inappropriately in 8% to 38% of the cases (5-9).

Our study was designed to assess the knowledge and skill base of the attending and resident physicians in our hospital in the ordering of parenteral nutrition.

METHODS

This assessment was conducted in April and May 1994 at St Elizabeth Health Center, Youngstown, Ohio, and included attending physicians, residents, and medical students in the departments of Family Medicine, Internal Medicine, and General Surgery.

Participants completed a demographic data sheet. They provided information about their medical specialty, age, sex, year graduated from medical school, postgraduate year in residence or number of years in practice, and the approximate number of lectures on general nutrition and specifically parenteral nutrition that they attended during their medical school and residency training. Physicians also recorded the approximate number of patients for whom they ordered parenteral nutrition in the past year.

[TABULAR DATA FOR TABLE 1 OMITTED]

[TABULAR DATA FOR TABLE 2 OMITTED]

[TABULAR DATA FOR TABLE 3 OMITTED]

Physicians then were asked to write parenteral nutrition and intravenous fluid orders for three mock patients. A two- to three-paragraph case study, which included laboratory data, was provided on each mock patient. If the physician did not think parenteral nutrition was indicated for that patient, then no orders were to be written. If parenteral nutrition was ordered, the physician was to complete the accompanying parenteral nutrition order sheet to provide the full amount of protein, nonprotein energy, and other additives as appropriate for the clinical …