Evaluating Gaps in Care of Malnourished Patients on General Medicine Floors in an Acute Care Setting

Chambers, Rachel C.; Bryan, Joanna; Jannat‐Khah, Deanna; Russo, Emily; Merriman, Louise; Gupta, Renuka

doi:10.1002/ncp.10097

Cited by 10 publications

(11 citation statements)

References 21 publications

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“…[14] However, gaps were also determined for patients whose diet instructions were not restrictive enough, were overly restrictive, had inappropriate texture or had an inaccurate EN/PN order. [6] Some of these discharge issues may have more impact on health outcomes than others and a future study with larger numbers should investigate their individual association with readmission. Additionally, our findings may suggest that ensuring appropriate discharge instructions is not enough to prevent readmission and that post discharge interventions could be more effective.…”

Section: Discussionmentioning

confidence: 99%

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Impact of gaps in care for malnourished patients on length of stay and hospital readmission

Ringel

Jannat‐Khah

Chambers

et al. 2019

BMC Health Serv Res

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BackgroundFew published articles have focused on identifying the gaps in care that follow a malnutrition diagnosis and their effects on length of stay (LOS) and 90-day readmission. We hypothesized that length of stay and readmission were associated with these gaps in care.MethodsTwo registered dietitians retrospectively reviewed charts of 229 adult malnourished patients admitted to a medicine unit to determine their system level gap in care: communication, test delay, or discharge planning. In this secondary analysis, both readmission and length of stay were regressed on each gap in care.ResultsAny system level gap was associated with a greater length of stay (β: 1.48, 95% CI: 1.15–1.91) and specifically the gap related to procedure/testing (β: 2.01, 95% CI: 1.62–2.47) resulted in a two-fold increase in length of stay. There was no association between 90-day readmission and any of the gaps in care.ConclusionsThere was a strong association between those who had any gap in their care and increased length of stay. Mitigating gaps in care may decrease length of stay and, in turn, result in less risk of infection and could potentially lead to reduced healthcare costs.

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Section: Discussionmentioning

confidence: 99%

“…Suboptimal malnutrition management was common, with 76% of these patients having at least one gap in their care. Using the same sample, in this secondary analysis, we hypothesized that these gaps were associated with increased length of stay and increase in 90-day readmission [6].…”

Section: Introductionmentioning

confidence: 99%

Impact of gaps in care for malnourished patients on length of stay and hospital readmission

Ringel

Jannat‐Khah

Chambers

et al. 2019

BMC Health Serv Res

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“…Malnutrition is associated with poor clinical outcomes, higher mortality rates and increased length of stay in hospital settings ( 30 , 31 ). The nutritional and hydrational outcomes of NPO have been explored in conditions such as stroke and critical illness, demonstrating higher mortality in patients with no early enteral nutrition ( 32 – 34 ). NPO has often been shown to be a contributor to hospital-acquired malnutrition ( 34 ).…”

Section: Introductionmentioning

confidence: 99%

Nil per os in the management of oropharyngeal dysphagia—exploring the unintended consequences

Cimoli,

Gibney,

Lim

et al. 2024

Front. Rehabil. Sci.

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Nil per os (NPO), also referred to as Nil by Mouth (NBM), is a health-related intervention of withholding food and fluids. When implemented in the context of a person with dysphagia, NPO aims to mitigate risks of aspiration. However, evidence demonstrating that NPO is beneficial as an intervention for people with dysphagia is lacking. This paper explores the theoretical and empirical evidence relating to the potential benefits and adverse effects of NPO and asserts that NPO is not a benign intervention. This paper argues for applying an ethics framework when making decisions relating to the use of NPO as an intervention for dysphagia, in particular addressing informed consent and a person's right to self-determination.

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“…Studies examining modifiable determinants of hospital‐acquired malnutrition are limited. In one study, 76% of malnourished patients experienced at least one institution‐level care gap including poor dietitian–physician communication, inappropriate nil‐by‐mouth (NBM) orders or inaccurate dietetic discharge instructions 18 . NBM is often prescribed inappropriately as a result of updated clinical practice guidelines not being widely adopted 19,20 .…”

Section: Introductionmentioning

confidence: 99%

“…In one study, 76% of malnourished patients experienced at least one institution‐level care gap including poor dietitian–physician communication, inappropriate nil‐by‐mouth (NBM) orders or inaccurate dietetic discharge instructions. 18 NBM is often prescribed inappropriately as a result of updated clinical practice guidelines not being widely adopted. 19 , 20 Evidence suggests a strong association between any care‐related gap and increased length of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of hospital‐acquired malnutrition and modifiable determinants of nutritional deterioration during inpatient admissions: A systematic review of the evidence

Cass

Charlton

2022

J Human Nutrition Diet

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Background Malnutrition affects between 20% and 50% of hospital inpatients on admission, with further declines expected during hospitalisation. This review summarises the existing literature on hospital‐acquired malnutrition that examines the magnitude of nutritional deterioration amongst adult inpatients and identifies preventable barriers to optimising nutrition support during episodes of care. Methods A systematic review was conducted to answer the question: Among adult hospital inpatients, the presence of which modifiable factors contribute to hospital‐acquired malnutrition? A database search was conducted between the 24 April and 30 June 2020 using CINAHL, MEDLINE, Scopus and PubMed databases according to a protocol registered with PROSPERO (CD42020182728). In addition, issues of the 10 top clinical nutrition journals published during the period of from 1 April 2015 to 30 March 2020 were hand‐searched. Results Fifteen articles were eligible for inclusion from a total of 5944 retrieved abstracts. A narrative synthesis of evidence was completed because of the high level of heterogeneity in methodologies. Nutritional deterioration is common among previously well‐nourished and nutritionally compromised patients, with studies reporting that 10%–65% of patients experienced nutritional decline. Frequently reported barriers were mealtime interruptions, meal dissatisfaction, procedure‐related fasting, effects of illness or treatment, chewing difficulties, poor appetite and malnutrition as a low clinical priority. Conclusions The findings of this review support the need for routine nutritional risk screening throughout each hospital admission with hospital‐acquired malnutrition affecting up to 65% of inpatients. Clear establishment of the roles and responsibilities of each member within multidisciplinary healthcare teams in the provision of nutrition care and cost–benefit analyses are recommended to demonstrate the effectiveness of changes to models of care.

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Evaluating Gaps in Care of Malnourished Patients on General Medicine Floors in an Acute Care Setting

Cited by 10 publications

References 21 publications

Impact of gaps in care for malnourished patients on length of stay and hospital readmission

Impact of gaps in care for malnourished patients on length of stay and hospital readmission

Nil per os in the management of oropharyngeal dysphagia—exploring the unintended consequences

Prevalence of hospital‐acquired malnutrition and modifiable determinants of nutritional deterioration during inpatient admissions: A systematic review of the evidence

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