Nutrition and Metabolic Support Service: The Synergy of a Multidisciplinary Team


When it comes to a minor ailment, there is no disputing the comfort that a bowl of chicken noodle soup brings — whether or not it helps us mend. However, no matter what you believe about the power of that bowl of soup, nutrition science and how it relates to our well-being — especially when we’re plagued with a major medical challenge — is tremendously complex and proven to positively affect patient outcomes. And, thanks to a multidisciplinary Nutrition and Metabolic Support Service Team (NST), patients at Emory Healthcare have nutrition on their side.

“For decades, the NST has played a role in the support of inpatients and outpatients from all disciplines,” explains Tom Ziegler, MD, one of the two physicians on the team. “Malnutrition, muscle loss and micronutrient deficiency remain challenges. Our team identifies and treats these forms of malnutrition, often providing calories, proteins, essential fats, vitamins and minerals via the gastrointestinal tract or intravenously.”

The NST is also actively involved in research and teaching, with trainees from a variety of disciplines and organizations. Furthermore, Emory Healthcare has one of only a few nationally accredited residency training programs in nutrition support for postdoctoral pharmacists.

In addition to two physicians, the NST is composed of registered nurses, clinical nutrition specialists and clinical pharmacists — all who have found great support from their disciplines and the Emory Healthcare community. “We have a lot of physician support,” comments Dan Griffith, clinical pharmacist. “They recognize the experience and continuity of our team as important assets.”

Power of the patients and their families

“We develop relationships with our patients,” says Nisha Dave, clinical pharmacist. “Nutrition is one part of their care they can control, which enables them to drive their destinies and improve their outcomes.”

This empowerment results in remarkable changes. “Nurses initiate a lot of our consults,” says Cindy Battey, registered nurse. “They are very aware of their patients and see the big picture. When we meet some of our patients, they can be ‘flat’ and depressed; however, we often see them transformed to hopeful and vibrant.”

“I have seen amazing results,” concurs Therese McNally, registered nurse. “People who were completely debilitated will have a total personality and quality of life change.”

Additionally, the family is a valued asset. “We speak with them and ask them to encourage the patient,” says Nisha. “They can also help monitor everything that a patient
is taking in, or even bring in favorite foods.”

The NST often helps patients transition home. They work with family members to evaluate the available home support structure. According to Glen Bergman, clinical nutrition specialist, “We work together to make these decisions — Is the patient ready to go home? The patient’s primary nurse is also an integral partner in assessing the patient’s readiness for home nutrition therapy. We always strive to provide optimal nutrition care through collaboration of the entire team.”


As mentioned, the NST is dedicated to research in nutrition, helping define the science for current and future generations. “In the realm of medicine, there’s not a lot of complete nutrition information out there,” explains Vivian Zhao, clinical pharmacist. “It is exciting to discover what we can do to help our patients.”

“The NST has been actively involved in clinical research relevant to improving best practices in enteral and parenteral nutrition support in adult populations for years,” confirms Tom.

The group has and is investigating the modes of parenteral and enteral nutrition as they relate to bone marrow transplantation, liver failure, critical and catabolic illnesses, and intestinal failure. For example, the NST is leading a National Institutes of Health-funded, multi-organizational study of glutamine-supplemented nutrition and how it affects clinical outcomes in critically ill patients requiring nutrition support after cardiac, vascular and intestinal surgery.

Whether through conducting such research, providing direct patient care or teaching others, the NST is set to maintain its position at the forefront of nutrition science. With every finding — such as their development of a nursing procedure for placing nasojejunal feeding tubes in ICU patients at the bedside — the NST advances patient care and outcomes.

Pictured: (l-r) Dan Griffith, Therese McNally, Vivian Zhao, Cindy Battey, Nisha Dave and Glen Bergman. (not pictured) Tom Ziegler, MD, and John Galloway, MD, NST physicians; and Nicole Daignault, clinical nutrition specialist.