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

Abstract

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.

Malnutrition identification and management variability: An administrative database study of children with solid tumors

“…Admissions with malnutrition diagnoses required a longer LOS, consistent with existing literature 26–29 . We also found that malnutrition inpatient encounters were more likely to be admitted through the emergency department and were associated with an increase in opioid prescription.…”

“…24,25 Admissions with malnutrition diagnoses required a longer LOS, consistent with existing literature. [26][27][28][29] We also found that malnutrition inpatient encounters were more likely to be admitted through the emergency department and were associated with an increase in opioid prescription. Early identification and treatment of at-risk patients for could lead decreased LOS and emergency department visits.…”

“…Regardless, proper nutrition may play a role in decreasing hospital LOS and emergency department utilization which has been suggested to contribute to avoiding delays or dose reductions in treatment. [23][24][25][26] Although adult studies have demonstrated worsened overall survival with cancer cachexia, it has only been postulated that pediatric survival is directly impacted by nutrition status and this will need to be examined in future studies. 30 The There are limitations that are important to recognize in this study.…”

“…Additionally, it may support the need for increased nutrition support among patients with more complicated illnesses (those more highly affected use the emergency department and opioids). Regardless, proper nutrition may play a role in decreasing hospital LOS and emergency department utilization which has been suggested to contribute to avoiding delays or dose reductions in treatment 23–26 . Although adult studies have demonstrated worsened overall survival with cancer cachexia, it has only been postulated that pediatric survival is directly impacted by nutrition status and this will need to be examined in future studies 30 …”

Screening, Diagnosis, and Assessment of Malnutrition Risk Factors in a Hospital Care Setting Prior and Post a Multidisciplinary Educational Intervention. (c2020)

“…1.3,1.3, and 2.6 times, respectively, more likely to have a shorter LOS than patients who were underweight, had lower MUAC, and lower dietary diversity(Abrha et al, 2019).Regardless of the nutritional complications and implications that come hand in hand with malnutrition, there are several other reasons why malnutrition impacts length of stay Ringel et al (2019). suggested the presence of three gaps in the system that could translate into longer length of stay for malnourished patients: communication, delay in testing, or discharge planning.…”