ThedaCare Nutrition Risk Screen Improves the Identification of Non–Intensive Care Unit Patients at Risk for Malnutrition Compared With the Nutrition Risk Screen 2002

Hartz, Lori L. K.; Stroup, Bridget M.; Bibelnieks, Tracy A.; Shockey, Cheryl; Ney, Denise M.

doi:10.1002/jpen.1315

Cited by 11 publications

(8 citation statements)

References 30 publications

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“…Second, TGH implemented and evaluated a suite of hospital-wide QI interventions targeted to the needs of the organisation. Previous literature has demonstrated the promise of targeted interventions,16–21 25–28 but few articles have evaluated an institution-wide, multipronged model for detecting deficiencies in malnutrition care and implementing changes to address them. This study offers a unique assessment of the implementation of such a strategy.…”

Section: Resultsmentioning

confidence: 99%

“…A number of recent studies demonstrating successful results of QI programmes focused on malnutrition were published in a supplement to the Journal of the Academy of Nutrition and Dietetics that can be accessed at https://jandonline.org/issue/S2212-2672(19)X0003-9. While many studies evaluate the ability of specific screening tools to correctly identify malnutrition risk, few assess treatment and follow-up care activities 16–21. Studies looking at the impact of specific nutrition interventions have shown positive effects of an interdisciplinary care team developing and implementing a comprehensive nutrition care and discharge plan 8 14…”

Section: Introductionmentioning

confidence: 99%

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Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital

et al. 2020

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As many as 50% of hospitalised patients are estimated to be malnourished or at risk of malnutrition on hospital admission, but this condition often goes unrecognised, undiagnosed and untreated. Malnutrition is associated with an elevated need for continued medical interventions, higher costs of care and increased patient safety risks. Tampa General Hospital (TGH), a large teaching hospital in the southeastern USA, initiated a project to improve the quality of patient care at its institution. They did this first by focusing on improving the care quality for their malnourished patients (or patients who were at risk of malnourishment) and by using elements of the national Malnutrition Quality Improvement Initiative (MQii) Toolkit as a mechanism to measure and improve quality. The aim of this study was to evaluate the impact of quality improvement interventions on patient length of stay (LOS), infection rates and readmissions, particularly for malnourished patients. The structure of the MQii and the use of the MQii Toolkit helped staff members identify problems and systematically engage in quality improvement processes. Using the MQii Toolkit, TGH implemented a multipronged approach to improving the treatment of malnourished patients that involved creating interdisciplinary teams of staff and identifying gaps in care that could be improved through a series of changes to hospital-wide clinical workflows. They enhanced interdisciplinary coordination through increased dietitian engagement, the use of electronic health record alerts and new surgical protocols. These interventions lasted 8 months in 2016 and data reported here were collected from 985 patients before the interventions (2015) and 1046 patients after the interventions (2017). The study examines how these process changes affected LOS, infection rates and readmissions at TGH. Following implementation of these quality improvement processes, patients who were malnourished or at risk of malnutrition had a 25% reduction in LOS (from 8 to 6 days, p<0.01) and a 35.7% reduction in infection rates (from 14% to 9%, p<0.01). No statistically significant changes in readmission rates were observed. This study adds to a growing body of literature on quality improvement processes hospitals can undertake to better identify and treat malnourished patients. Hospitals and health systems can benefit from adopting similar institution-wide, quality improvement projects, while policy-makers’ support for such programmes can spur more rapid uptake of nutrition-focused initiatives across care delivery settings.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital

et al. 2020

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“…The sample size was estimated based on the malnutrition rates in patients with cirrhosis of 44•6 % assessed by the NRS-2002 and 50•7 % assessed by the RFH-NPT (16) . The reported sensitivity and specificity of nutritional risk screening by the NRS-2002 vary widely, with values of 50-86 and 21-93 %, respectively (23) . The calculated minimum sample size was 96, with a sensitivity and specificity of 50 %, an α of 0•05 and a power of 85 % (24) .…”

Section: Sample Size Estimationmentioning

confidence: 99%

Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002

Zhu

Feng

et al. 2020

Br J Nutr

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The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) to identify malnutrition risk in patients with liver disease. However, little is known about the application of RFH-NPT to screen for the risk of malnutrition in China, where patients primarily suffer from hepatitis virus-related cirrhosis. A total of 155 cirrhosis patients without liver cancer or uncontrolled comorbid illness were enrolled in this prospective study. We administered the Nutritional Risk Screening 2002 (NRS-2002), RFH-NPT, Malnutrition Universal Screening Tool(MUST), and Liver Disease Undernutrition Screening Tool (LDUST) to the patients within 24 h after admission and performed follow-up observations for 1.5 years. The RFH-NPT and NRS-2002 had higher sensitivities (64.8% and 52.4%) and specificities (60% and 70%) than the other tools with regard to screening for the malnutrition risk in cirrhotic patients. The prevalence of nutritional risk was higher under the use of RFH-NPT against the NRS-2002(63% vs. 51%). RFH-NPT tended more easily to detect the malnutrition risk in patients with advanced Child-Pugh classes (B and C) and lower MELD scores (<15) compared with NRS-2002. The RFH-NPT score was an independent predictive factor for mortality. Patients identified as being at high malnutrition risk with the RFH-NPT had a higher mortality rate than those at a low risk; the same result was not obtained with the NRS-2002. Therefore, we suggest that using RFH-NPT improves the ability of clinicians to predict malnutrition risk in patients with cirrhosis primarily caused by hepatitis virus infection at an earlier stage.

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“…Malnutrition is defined as any nutritional imbalance, which is a major complication in hospitalised patients and increases the length of stay (LOS), healthcare costs and mortality (7)(8)(9)(10)(11) . The prevalence of malnutrition is 15-80 % in hospitalised patients, while only 3 % could be diagnosed and treated (8,12) . It has been reported that over 40 % of CKD patients are undernourished (13) and uraemia and dialysis can impact the nutritional status of patients with kidney disease (14,15) .…”

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confidence: 99%

Malnutrition screening and acute kidney injury in hospitalised patients: a retrospective study over a 5-year period from China

Chen

et al. 2019

Br J Nutr

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Malnutrition and acute kidney injury (AKI) are common complications in hospitalised patients, and both increase mortality; however, the relationship between them is unknown. This is a retrospective propensity score matching study enrolling 46 549 inpatients, aimed to investigate the association between Nutritional Risk Screening 2002 (NRS-2002) and AKI and to assess the ability of NRS-2002 and AKI in predicting prognosis. In total, 37 190 (80 %) and 9359 (20 %) patients had NRS-2002 scores <3 and ≥3, respectively. Patients with NRS-2002 scores ≥3 had longer lengths of stay (12·6 (sd 7·8) v. 10·4 (sd 6·2) d, P < 0·05), higher mortality rates (9·6 v. 2·5 %, P < 0·05) and higher incidence of AKI (28 v. 16 %, P < 0·05) than patients with normal nutritional status. The NRS-2002 showed a strong association with AKI, that is, the risk of AKI changed in parallel with the score of the NRS-2002. In short- and long-term survival, patients with a lower NRS-2002 score or who did not have AKI achieved a significantly lower risk of mortality than those with a high NRS-2002 score or AKI. Univariate Cox regression analyses indicated that both the NRS-2002 and AKI were strongly related to long-term survival (AUC 0·79 and 0·71) and that the combination of the two showed better accuracy (AUC 0·80) than the individual variables. In conclusion, malnutrition can increase the risk of AKI and both AKI and malnutrition can worsen the prognosis that the undernourished patients who develop AKI yield far worse prognosis than patients with normal nutritional status.

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ThedaCare Nutrition Risk Screen Improves the Identification of Non–Intensive Care Unit Patients at Risk for Malnutrition Compared With the Nutrition Risk Screen 2002

Abstract: The ThedaCare NRS improves the identification of patients at risk for malnutrition in the non-intensive care unit hospital setting. This trial was registered at www.clinicaltrials.gov as NCT02585245.

Cited by 11 publications

References 30 publications

Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital

Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital

Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002

Malnutrition screening and acute kidney injury in hospitalised patients: a retrospective study over a 5-year period from China

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