Gauging food and nutritional care quality in hospitals

Proximity and information sharing in hospitals and nursing homes: Development of an instrument assessing health personnel's perceptions of proximity and information sharing with kitchen personnel

Healthcare services are becoming increasingly specialized, potentially hampering interprofessional care. To provide holistic treatment and care, different professions and departments need to share information. Healthcare services also include support services, such as institutional food services, and health personnel and kitchen personnel need to share information about food and patients to serve food adapted to the patients' nutritional needs. Healthcare institutions mainly use formal information-sharing systems, but informal communication is considered more suitable for exchanging complex information. Physical and social proximity may facilitate informal information sharing across different professions and units. We aimed to develop and test an instrument for assessing health personnel's perceptions of physical and social proximity to, and information-sharing practices with, kitchen personnel and to describe associations between physical and social proximity and information-sharing practices. A survey questionnaire measuring proximity and information-sharing practices was developed and distributed to 368 health personnel. Scale analyses were performed to test the psychometric properties of the measures included in the questionnaire. MANOVA and regression analyses were run to assess associations between proximity and information-sharing practices. The results indicated reasonable validity of the measures, and both physical and social proximity were associated with increased informal information sharing.

RELATIONSHIP BETWEEN NUTRITIONAL STATUS AND THE CLINICAL OUTCOMES OF PATIENTS WITH AND WITHOUT NEOPLASMS ACCORDING TO MULTIPLE CORRESPONDENCE ANALYSIS

ABSTRACT BACKGROUND For many years, many studies have reported undesirable outcomes that may occur during the hospital stay of patients diagnosed with malnutrition or even at some nutritional risk. OBJECTIVE To investigate the relationship between nutritional status and clinical outcomes during hospital stay using the multiple correspondence analysis technique. METHODS This cross-sectional study included 600 patients with and without neoplasms. The following data were collected: subjective global assessment, nutritional indicators, nutritional risk screening, anthropometric data (body mass index (BMI), mid-upper arm circumference (MUAC), mid-upper arm muscle circumference (MUAMC), triceps skinfold thickness (TST), recent weight loss (RWL)), and habitual energy intake (HEI/ER <75%). The clinical outcomes of interest were complications, length of hospital stay (LOHS), and death. The data were analyzed by the chi-square or Fisher’s exact test at a significance level of 5%. Multiple correspondence analysis was used for the multivariate data analysis. RESULTS The multiple correspondence analysis map for the patients with neoplasms showed that the following characteristics were associated and represented by death, complications, and a greater likelihood of LOHS ≥7 days: underweight according to BMI; TST, MUAC, and MUAMC ≤15th percentile; malnutrition according to the subjective global assessment; at nutritional risk according to the nutritional risk screening; being male; age ≥60 years; and HEI/ER <75%. The multiple correspondence analysis map for the patients without neoplasms showed that the following characteristics were associated and represented by death: underweight according to BMI; TST ≤15th percentile; malnutrition according to the subjective global assessment; and at nutritional risk according to the nutritional risk screening. Complications and LOHS ≥7 days represented the categories male, no recent weight loss, HEI/ER <75%, MUAC and MUAMC ≤15th percentile, TST between the 15th and 85th percentiles, and age <60 years. CONCLUSION The results of this study confirm an association between unsatisfactory nutritional indicators and undesirable clinical outcomes.

Factors associated with nutritional decline in hospitalised medical and surgical patients admitted for 7 d or more: a prospective cohort study

This prospective cohort study was conducted in eighteen Canadian hospitals with the aim of examining factors associated with nutritional decline in medical and surgical patients. Nutritional decline was defined based on subjective global assessment (SGA) performed at admission and discharge. Data were collected on demographics, medical information, food intake and patients' satisfaction with nutrition care and meals during hospitalisation; 424 long-stay (≥7 d) patients were included; 38% of them had surgery; 51% were malnourished at admission (SGA B or C); 37% had in-hospital changes in SGA; 19·6% deteriorated (14·6% from SGA A to B/C and 5% from SGA B to C); 17·4% improved (10·6% from SGA B to A, 6·8% from SGA C to B/A); and 63·0 % patients were stable (34·4% were SGA A, 21·3% SGA B, 7·3% SGA C). One SGA C patient had weight loss ≥5%, likely due to fluid loss and was designated as stable. A subset of 364 patients with admission SGA A and B was included in the multiple logistic regression models to determine factors associated with nutritional decline. After controlling for SGA at admission and the presence of a surgical procedure, lower admission BMI, cancer, two or more diagnostic categories, new in-hospital infection, reduced food intake, dissatisfaction with food quality and illness affecting food intake were factors significantly associated with nutritional decline in medical patients. For surgical patients, only male sex was associated with nutritional decline. Factors associated with nutritional decline are different in medical and surgical patients. Identifying these factors may assist nutritional care.