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Roberts S, Marshall AP, Bromiley L, Hopper Z, Byrnes J, Ball L, Collins PF, Kelly J. Patient-Led, Technology-Assisted Malnutrition Risk Screening in Hospital: A Feasibility Study. Nutrients 2024; 16:1139. [PMID: 38674830 PMCID: PMC11055004 DOI: 10.3390/nu16081139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Malnutrition risk screening is crucial to identify at-risk patients in hospitals; however, screening rates can be suboptimal. This study evaluated the feasibility, acceptability, and potential cost-effectiveness of patient-led, technology-assisted malnutrition risk screening. A prospective multi-methods study was conducted in a 750-bed public hospital in Australia. Patients were recruited from seven wards and asked to complete an electronic version of the Malnutrition Screening Tool (e-MST) on bedside computer screens. Data were collected on feasibility, acceptability, and cost. Feasibility data were compared to pre-determined criteria on recruitment (≥50% recruitment rate) and e-MST completion (≥75% completion rate). Quantitative acceptability (survey) data were analyzed descriptively. Patient interview data were analyzed thematically. The economic evaluation was from the perspective of the health service using a decision tree analytic model. Both feasibility criteria were met; the recruitment rate was 78% and all 121 participants (52% male, median age 59 [IQR 48-69] years) completed the e-MST. Patient acceptability was high. Patient-led e-MST was modeled to save $3.23 AUD per patient and yield 6.5 more true malnutrition cases (per 121 patients) with an incremental cost saving per additional malnutrition case of 0.50 AUD. Patient-led, technology-assisted malnutrition risk screening was found to be feasible, acceptable to patients, and cost-effective (higher malnutrition yield and less costly) compared to current practice at this hospital.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Southport, QLD 4222, Australia;
- Allied Health Research, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Andrea P. Marshall
- School of Nursing and Midwifery, Griffith University, Southport, QLD 4222, Australia;
- Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Leisa Bromiley
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia;
| | - Zane Hopper
- School of Health Sciences and Social Work, Griffith University, Southport, QLD 4222, Australia;
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia;
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222, Australia;
- School of Medicine and Dentistry, Griffith University, Southport, QLD 4222, Australia
| | - Lauren Ball
- Centre for Community Health and Wellbeing, The University of Queensland, St Lucia, QLD 4072, Australia;
| | - Peter F. Collins
- Faculty of Medicine and Health, Sydney Nursing School/Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW 2006, Australia;
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Jaimon Kelly
- Centre for Online Health, The University of Queensland, Woolloongabba, QLD 4102, Australia;
- Centre for Health Services Research, The University of Queensland, Woolloongabba, QLD 4102, Australia
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McCray S, Barsha L, Maunder K. Implementation of an electronic solution to improve malnutrition identification and support clinical best practice. J Hum Nutr Diet 2022; 35:1071-1078. [PMID: 35510388 DOI: 10.1111/jhn.13026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/25/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Routine malnutrition risk screening of patients is critical for optimal care and comprises part of the National Australian Hospital Standards. Identification of malnutrition also ensures reimbursement for hospitals to adequately treat these high-risk patients. However, timely, accurate screening, assessment and coding of malnutrition remains suboptimal. The present study aimed to investigate manual and digital interventions to overcome barriers to malnutrition identification for improvements in the hospital setting. METHODS Retrospective reporting on malnutrition identification processes was conducted through two stages: (1) manual auditing intervention and (2) development of a digital solution - the electronic malnutrition management solution (eMS). Repeated process audits were completed at approximately 6-monthly intervals through both stages between 2016 and 2019 and the results were analysed. In Stage 2, time investment and staff adoption of the digital solution were measured. RESULTS Overall, the combined effect of both regular auditing and use of the eMS resulted in statistically significant improvements across all six key measures: patients identified (97%-100%; p < 0.001), screened (68%-95%; p < 0.001), screened within 24 h (51%-89%; p < 0.001), assessed (72%-95%; p < 0.001), assessed within 24 h (66%-93%; p < 0.001) and coded (81%-100%; p = 0.017). The eMS demonstrated a reduction in screening time by over 60% with user adoption 100%. Data analytics enabled automated, real-time auditing with a 95% reduction in time taken to audit. CONCLUSIONS A single digital solution for management of malnutrition and automation of auditing demonstrated significant improvements where manual or combinations of manual and electronic systems continue to fall short.
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Affiliation(s)
- Sally McCray
- Dept of Dietetics and Foodservices, Mater Group, Raymond Terrace, South Brisbane, QLD, Australia.,Mater Research Institute, University of Queensland Brisbane, QLD, Australia
| | - Laura Barsha
- Dept of Dietetics and Foodservices, Mater Group, Raymond Terrace, South Brisbane, QLD, Australia.,Mater Research Institute, University of Queensland Brisbane, QLD, Australia
| | - Kirsty Maunder
- The CBORD Group, Sydney, NSW, Australia.,University of Wollongong, Faculty of Science, Medicine and Health, Wollongong, NSW, Australia
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Sánchez-Encalada S, Talavera-Torres MM, Villa-Romero AR, Agudelo-Botero M, Wong-Chew RM. Impact Evaluation of An Interdisciplinary Educational Intervention to Health Professionals for the Treatment of Mild to Moderate Child Malnutrition in Mexico: A Difference-in-Differences Analysis. Healthcare (Basel) 2022; 10:healthcare10122411. [PMID: 36553935 PMCID: PMC9778150 DOI: 10.3390/healthcare10122411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/13/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022] Open
Abstract
The prevalence of undernutrition in Mexican children younger than 5 years old has been 14% since 2006. There are clinical practice guidelines for mild to moderate malnutrition in children in the Mexican health system; however, they are not applied. In addition, the knowledge and practices of health professionals (HP) to treat malnutrition in health centers are insufficient to perform adequate assessments and correct treatments. An impact evaluation of an interdisciplinary educational intervention was carried out on 78 HPs for the treatment of children with mild to moderate malnutrition of low resources, with 39 in the intervention group and 37 in the counterfactual group, estimated as the comparison group. A Food and Agriculture Organization (FAO)-validated questionnaire adapted to child malnutrition about knowledge, attitudes, and practices was applied before, after, and 2 months after a malnutrition workshop. The difference-in-differences analysis showed that the educational intervention group had a significant improvement in knowledge, attitudes, and practices before and after the intervention (grades of 54.6 to 79.2 respectively, p = 0.0001), compared with the comparison group (grades of 79.2 and 53.4, respectively, p = 0.0001), which was maintained over two months (grades of 71.8 versus 49.8, p = 0.0001, respectively). The multivariate analysis showed that the probability of improvement in learning by 30% was 95-fold higher in the educational intervention group versus the comparison group, OR = 95.1 (95% CI 14.9-603.0), and this factor was independent of sex, age, education, or hospital position. Despite the availability of clinical practice guidelines for the assessment and treatment for child malnutrition, education in malnutrition for HPs is effective and needed to achieve a significant improvement in children's health.
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Affiliation(s)
- Sonia Sánchez-Encalada
- División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Mexico City 04510, Mexico
| | | | - Antonio R. Villa-Romero
- División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Mexico City 04510, Mexico
| | - Marcela Agudelo-Botero
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Mexico City 04510, Mexico
| | - Rosa María Wong-Chew
- División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Mexico City 04510, Mexico
- Correspondence: ; Tel.: +52-5556232298
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Chrástecká M, Blanař V, Pospíchal J. Risk of malnutrition assessment in hospitalised adults: A scoping review of existing instruments. J Clin Nurs 2022. [DOI: 10.1111/jocn.16470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Marie Chrástecká
- Faculty of Health Studies University of Pardubice Pardubice Czech Republic
| | - Vít Blanař
- Faculty of Health Studies University of Pardubice Pardubice Czech Republic
- Department of Otorhinolaryngology and Head and Neck Surgery Pardubice Hospital, Hospitals of the Pardubice Region Pardubice Czech Republic
| | - Jan Pospíchal
- Faculty of Health Studies University of Pardubice Pardubice Czech Republic
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Ford KL, Prado CM, Weimann A, Schuetz P, Lobo DN. Unresolved issues in perioperative nutrition: A narrative review. Clin Nutr 2022; 41:1578-1590. [PMID: 35667274 DOI: 10.1016/j.clnu.2022.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 12/23/2022]
Abstract
Surgical patients are at an increased risk of negative outcomes if they are malnourished or at risk of malnutrition preoperatively. Optimisation of nutritional status should be a focus throughout the perioperative continuum to promote improved surgical outcomes. Enhanced Recovery after Surgery (ERAS) protocols are increasingly applied in the surgical setting but are not yet widespread. This narrative review focused on areas of perioperative nutrition that are perceived as controversial or are lacking in agreement. A search for available literature was conducted on 1 March 2022 and relevant high-quality articles published since 2015 were considered for inclusion. Most malnutrition screening tools are not specific to the surgical population except for the Perioperative Nutrition Screen (PONS) although more large-scale initiatives are needed to improve the prevalence of preoperative nutrition screening. Poor muscle health is common in patients with malnutrition and further exacerbates negative health outcomes indicating that prevention, detection and treatment is of high importance in this population. Although a lack of consensus remains for who should receive preoperative nutritional therapy, evidence suggests a positive impact on muscle health. Additionally, postoperative nutritional support benefits surgical outcomes, with some patients requiring enteral and/or parenteral feeding routes and showing benefit from immunonutrition. The importance of nutrition extends beyond the time in hospital and should remain a priority post-discharge. The impact of individual or personalised nutrition based on select patient characteristics remains to be further investigated. Overall, the importance of perioperative nutrition is evident in the literature despite select ongoing areas of contention.
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Affiliation(s)
- Katherine L Ford
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, Klinikum St. Georg, Leipzig, Germany
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
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Serón-Arbeloa C, Labarta-Monzón L, Puzo-Foncillas J, Mallor-Bonet T, Lafita-López A, Bueno-Vidales N, Montoro-Huguet M. Malnutrition Screening and Assessment. Nutrients 2022; 14:2392. [PMID: 35745121 PMCID: PMC9228435 DOI: 10.3390/nu14122392] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023] Open
Abstract
Malnutrition is a serious problem with a negative impact on the quality of life and the evolution of patients, contributing to an increase in morbidity, length of hospital stay, mortality, and health spending. Early identification is fundamental to implement the necessary therapeutic actions, involving adequate nutritional support to prevent or reverse malnutrition. This review presents two complementary methods of fighting malnutrition: nutritional screening and nutritional assessment. Nutritional risk screening is conducted using simple, quick-to-perform tools, and is the first line of action in detecting at-risk patients. It should be implemented systematically and periodically on admission to hospital or residential care, as well as on an outpatient basis for patients with chronic conditions. Once patients with a nutritional risk are detected, they should undergo a more detailed nutritional assessment to identify and quantify the type and degree of malnutrition. This should include health history and clinical examination, dietary history, anthropometric measurements, evaluation of the degree of aggression determined by the disease, functional assessment, and, whenever possible, some method of measuring body composition.
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Affiliation(s)
- Carlos Serón-Arbeloa
- Intensive Care Unit, Department of Medicina, University Hospital San Jorge, 22004 Huesca, Spain; (L.L.-M.); (T.M.-B.); (A.L.-L.); (N.B.-V.)
- Faculty of Health and Sports Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Lorenzo Labarta-Monzón
- Intensive Care Unit, Department of Medicina, University Hospital San Jorge, 22004 Huesca, Spain; (L.L.-M.); (T.M.-B.); (A.L.-L.); (N.B.-V.)
- Faculty of Health and Sports Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - José Puzo-Foncillas
- Faculty of Health and Sports Sciences, University of Zaragoza, 50009 Zaragoza, Spain
- Clinical Analysis and Biochemistry Service, Department of Medicina, University Hospital San Jorge, 22004 Huesca, Spain;
| | - Tomas Mallor-Bonet
- Intensive Care Unit, Department of Medicina, University Hospital San Jorge, 22004 Huesca, Spain; (L.L.-M.); (T.M.-B.); (A.L.-L.); (N.B.-V.)
- Faculty of Health and Sports Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Alberto Lafita-López
- Intensive Care Unit, Department of Medicina, University Hospital San Jorge, 22004 Huesca, Spain; (L.L.-M.); (T.M.-B.); (A.L.-L.); (N.B.-V.)
- Faculty of Health and Sports Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Néstor Bueno-Vidales
- Intensive Care Unit, Department of Medicina, University Hospital San Jorge, 22004 Huesca, Spain; (L.L.-M.); (T.M.-B.); (A.L.-L.); (N.B.-V.)
- Faculty of Health and Sports Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Miguel Montoro-Huguet
- Faculty of Health and Sports Sciences, University of Zaragoza, 50009 Zaragoza, Spain
- Unit of Gastroenterology, Hepatology, and Nutrition, Department of Medicina, University Hospital San Jorge, 22004 Huesca, Spain
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