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Gomes K, Bell J, Desbrow B, Roberts S. Lost in Transition: Insights from a Retrospective Chart Audit on Nutrition Care Practices for Older Australians with Malnutrition Transitioning from Hospital to Home. Nutrients 2024; 16:2796. [PMID: 39203932 PMCID: PMC11357024 DOI: 10.3390/nu16162796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 08/10/2024] [Accepted: 08/20/2024] [Indexed: 09/03/2024] Open
Abstract
Care transitions from hospital to home for older adults with malnutrition present a period of elevated risk; however, minimal data exist describing the existing practice. This study aimed to describe the transition of nutrition care processes provided to older adults in a public tertiary hospital in Australia. A retrospective chart audit conducted between July and October 2022 included older (≥65 years), malnourished adults discharged to independent living. Dietetic care practices (from inpatient to six-months post-discharge) were reported descriptively. Of 3466 consecutive admissions, 345 (10%) had a diagnosis of malnutrition documented by the dietitian and were included in the analysis. The median number of dietetic visits per admission was 2.0 (IQR 1.0-4.0). Nutrition-focused discharge plans were inconsistently developed and documented. Only 10% of patients had nutrition care recommendations documented in the electronic discharge summary. Post-discharge oral nutrition supplementation was offered to 46% and accepted by 34% of the patients, while only 23% attended a follow-up appointment with dietetics within six months of hospital discharge. Most patients who are seen by dietitians and diagnosed with malnutrition appear lost in transition from hospital to home. Ongoing work is required to explore determinants of post-discharge nutrition care in this vulnerable population.
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Affiliation(s)
- Kristin Gomes
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia; (J.B.); (B.D.); (S.R.)
| | - Jack Bell
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia; (J.B.); (B.D.); (S.R.)
- Allied Health Research Collaborative, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD 4032, Australia
| | - Ben Desbrow
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia; (J.B.); (B.D.); (S.R.)
| | - Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia; (J.B.); (B.D.); (S.R.)
- Allied Health Research, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4219, Australia
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2
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Papoutsakis C, Sundar C, Woodcock L, Abram JK, Lamers-Johnson E. Translating malnutrition care from the hospital to the community setting. Nutr Clin Pract 2024. [PMID: 39105676 DOI: 10.1002/ncp.11197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/20/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024] Open
Affiliation(s)
- Constantina Papoutsakis
- Data Science Center, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Charanya Sundar
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Lindsay Woodcock
- Data Science Center, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Jenica K Abram
- Nutrition Research Network, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Erin Lamers-Johnson
- Nutrition Research Network, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
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3
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Hansen MC, Uhrenfeldt L, Ingstad K, Pedersen PU. Educational nutritional intervention to prevent loss of health-related quality of life among older adults after a surgical treatment: design of a randomised controlled trial. Trials 2024; 25:262. [PMID: 38622729 PMCID: PMC11017647 DOI: 10.1186/s13063-024-08096-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Disease-related malnutrition after a hospital stay has major consequences for older adults, the healthcare system and society. This study aims to develop and test the effectiveness of an educational video to prevent loss of health-related quality of life among live-at-home older adults after surgical treatment in a hospital. METHOD This randomised controlled trial will occur at a regional hospital in Norway. Participants will be live-at-home adults aged 65 years and older. They will be recruited from three different surgical departments after a surgical procedure. Individuals with a body mass index below 24 and a home address in one of nine selected municipalities will be eligible for inclusion. Participants will be randomly assigned to either the intervention group or the control group. Those assigned to the intervention group will obtain access to a 6-min educational video 5 days after being discharged from the hospital. The control group will not obtain access to the video. The primary outcome will be health-related quality of life using the Norwegian Rand 36-Item Short Form Health Survey. Furthermore, we will measure body composition, number of readmissions and nutritional knowledge at inclusion and 3-month follow-up. DISCUSSION This randomised controlled trial is expected to provide insight into whether an educational video can improve the nutritional status of older adults following a surgical procedure and discharge from the hospital. The findings will be useful for assessing how videos offering nutritional advice to older adults who have undergone a surgical procedure can improve their health-related quality of life, reduce loss of function, prevent readmission to hospital and reduce healthcare costs. TRIAL REGISTRATION ClinicalTrials.gov NCT05950373. Registered on 11 July 2023.
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Affiliation(s)
| | - Lisbeth Uhrenfeldt
- Institute for Regional Health Research, Southern Danish University, Ortopedic dep., Lillebaelt University Hospital, Odense, Denmark
| | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Preben U Pedersen
- Department of Clinical Medicine, Centre of Clinical Guidelines, Aalborg University, Aalborg, Denmark
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Ng DHL, Koh FHX, Yeong HEL, Huey TCW, Chue KM, Foo FJ, Chew STH. Nutrition Care after Hospital Discharge in Singapore: Evidence-Based Best-Practice Recommendations. Nutrients 2023; 15:4492. [PMID: 37960145 PMCID: PMC10650134 DOI: 10.3390/nu15214492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023] Open
Abstract
The nutritional status of hospitalised patients is often at risk or compromised and predisposed to further deterioration after discharge, leading to poor clinical outcomes, high healthcare costs, and poor quality of life. This paper aims to provide evidence-based best-practice recommendations to address this, supported by a national survey of healthcare professionals in Singapore and reviewed by a multidisciplinary expert panel under the Sarcopenia Interest Group of Society of Parenteral and Enteral Nutrition Singapore (SingSPEN). We advocate screening all patients with a validated tool which includes a disease activity/burden component, an easily accessible dietitian referral pathway for patients at risk of malnutrition, and an individualised nutrition care plan formulated and delivered using a multidisciplinary team approach for patients at risk or with malnutrition. A comprehensive team would include not only dietitians but also physicians, nurses, physiotherapists, speech therapists, and medical social workers working together towards a common goal. Information on why nutrition is important for good health and how it can be achieved should also be provided to all patients and their caregivers before and after hospital discharge. With the above recommendations, we seek to improve upon the current nutrition care processes at discharge for healthcare institutions in Singapore.
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Affiliation(s)
- Doris Hui Lan Ng
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
| | - Frederick Hong Xiang Koh
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Hazel Ee Ling Yeong
- Department of Nutrition and Dietetics, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore;
| | - Terence Cheong Wei Huey
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
| | - Koy Min Chue
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Fung Joon Foo
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Samuel Teong Huang Chew
- Department of Geriatric Medicine, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore;
- SingHealth Duke-NUS Medicine Academic Clinical Programme, 8 College Road, Singapore 169857, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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Bell JJ, Rushton A, Elmas K, Banks MD, Barnes R, Young AM. Are Malnourished Inpatients Treated by Dietitians Active Participants in Their Nutrition Care? Findings of an Exploratory Study of Patient-Reported Measures across Nine Australian Hospitals. Healthcare (Basel) 2023; 11:healthcare11081172. [PMID: 37108004 PMCID: PMC10138321 DOI: 10.3390/healthcare11081172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Inpatient malnutrition is a key determinant of adverse patient and healthcare outcomes. The engagement of patients as active participants in nutrition care processes that support informed consent, care planning and shared decision making is recommended and has expected benefits. This study applied patient-reported measures to identify the proportion of malnourished inpatients seen by dietitians that reported engagement in key nutrition care processes. METHODS A subset analysis of a multisite malnutrition audit limited to patients with diagnosed malnutrition who had at least one dietitian chart entry and were able to respond to patient-reported measurement questions. RESULTS Data were available for 71 patients across nine Queensland hospitals. Patients were predominantly older adults (median 81 years, IQR 15) and female (n = 46) with mild/moderate (n = 50) versus severe (n = 17) or unspecified severity (n = 4) malnutrition. The median length of stay at the time of audit was 7 days (IQR 13). More than half of the patients included had two or more documented dietitian reviews. Nearly all patients (n = 68) received at least one form of nutrition support. A substantial number of patients reported not receiving a malnutrition diagnosis (n = 37), not being provided information about malnutrition (n = 30), or not having a plan for ongoing nutrition care or follow-up (n = 31). There were no clinically relevant trends between patient-reported measures and the number of dietitian reviews or severity of malnutrition. CONCLUSIONS Malnourished inpatients seen by dietitians across multiple hospitals almost always receive nutritional support. Urgent attention is required to identify why these same patients do not routinely report receiving malnutrition diagnostic advice, receiving information about being at risk of malnutrition, and having a plan for ongoing nutrition care, regardless of how many times they are seen by dietitians.
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Affiliation(s)
- Jack J Bell
- Allied Health, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Alita Rushton
- Allied Health, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Kai Elmas
- Allied Health, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
| | - Merrilyn D Banks
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
| | - Rhiannon Barnes
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
| | - Adrienne M Young
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD 4072, Australia
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6
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Blondal BS, Geirsdottir OG, Beck AM, Halldorsson TI, Jonsson PV, Sveinsdottir K, Ramel A. HOMEFOOD randomized trial-beneficial effects of 6-month nutrition therapy on body weight and physical function in older adults at risk for malnutrition after hospital discharge. Eur J Clin Nutr 2023; 77:45-54. [PMID: 36028775 PMCID: PMC9876791 DOI: 10.1038/s41430-022-01195-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/21/2022] [Accepted: 08/03/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVES Malnutrition is common among older adults. Dietary intervention studies in older adults aiming to improve anthropometrics measures and physical function have been inconsistent. We aimed to investigate the effects of nutrition therapy in combination with home delivered meals and oral nutritional supplements (ONS) in community-dwelling older adults discharged from hospital. METHODS A total of 106 participants (>65 years) were randomized into the intervention group (n = 53) and into the control group (n = 53). The intervention group received individual nutrition therapy (five in person visits and three phone calls) and freely delivered energy- and protein- rich foods, while the control group received standard care. Dietary intake, anthropometrics, and short physical performance battery (SPPB) were assessed at baseline and at endpoint. RESULTS Energy intake at baseline was similar in both groups (~1500 kcal at the hospital) but there was a significant increase in energy intake and body weight in the intervention group (+919 kcal/day and 1.7 kg, P < 0.001 in both cases) during the study period, compared to a significant decrease in both measures among controls (-815 kcal/day and -3.5 kg, P < 0.001 in both cases). SPPB score increased significantly in the intervention group while no changes were observed among controls. CONCLUSIONS Most Icelandic older adults experience substantial weight loss after hospital discharge when receiving current standard care. However, a 6-month multi-component nutrition therapy, provided by a clinical nutritionist in combination with freely delivered supplemental energy- and protein-dense foods has beneficial effects on body weight, physical function, and nutritional status. STUDY REGISTRATION This study was registered at ClinicalTrials.gov ( NCT03995303 ).
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Affiliation(s)
- B S Blondal
- Faculty of Food Science and Nutrition, School of Health Science, University of Iceland, Reykjavik, Iceland.
| | - O G Geirsdottir
- Faculty of Food Science and Nutrition, School of Health Science, University of Iceland, Reykjavik, Iceland
| | - A M Beck
- University College Copenhagen, Institute of Nursing and Nutrition, Sigurdsgade 26, 2200, Copenhagen, Denmark
- The Dietetic and Nutritional Research Unit, EFFECT, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 50, 2730, Herlev, Denmark
| | - T I Halldorsson
- Faculty of Food Science and Nutrition, School of Health Science, University of Iceland, Reykjavik, Iceland
| | - P V Jonsson
- The Icelandic Gerontological Research Institute, Tungata 26, 101, Reykjavik, Iceland
- Faculty of Medicine, School of Health, University of Iceland, Reykjavík, Iceland
- Department of Geriatrics, The National University Hospital of Iceland, Reykjavík, Iceland
| | | | - A Ramel
- Faculty of Food Science and Nutrition, School of Health Science, University of Iceland, Reykjavik, Iceland
- Matís ohf, Vinlandsleið 12, 113, Reykjavik, Iceland
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7
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Rattray M, Roberts S. Dietitians’ Perspectives on the Coordination and Continuity of Nutrition Care for Malnourished or Frail Clients: A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10060986. [PMID: 35742038 PMCID: PMC9223016 DOI: 10.3390/healthcare10060986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023] Open
Abstract
Malnutrition and frailty are common conditions that impact overall health and function. There is limited research exploring the barriers and enablers to providing coordinated nutrition care to malnourished or frail clients in the community (including transitions from hospital). This study aimed to explore dietitians’ experiences and perspectives on providing coordinated nutrition care for frail and malnourished clients identified in the community or being discharged from hospital. Semi-structured interviews with clinical/acute, community, and aged care dietitians across Australia and New Zealand were conducted. Interviews were 23–61 min long, audio recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. Eighteen dietitians participated in interviews, including five clinical, eleven community, and two residential aged care dietitians. Three themes, describing key factors influencing the transition and coordination of nutrition care, emerged from the analysis: (i) referral and discharge planning practices, processes, and quality; (ii) dynamics and functions within the multidisciplinary team; and (iii) availability of community nutrition services. Guidelines advising on referral pathways for malnourished/frail clients, improved communication between acute and community dietitians and within the multidisciplinary team, and solutions for community dietetic resource shortages are required to improve the delivery of coordinated nutrition care to at-risk clients.
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Affiliation(s)
- Megan Rattray
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
- College of Medicine & Public Health, Flinders University, Adelaide 5042, Australia
- Correspondence:
| | - Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
- Allied Health Research, Gold Coast Hospital and Health Service, Gold Coast 4215, Australia
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Laur C, Bell J, Valaitis R, Ray S, Keller H. The role of trained champions in sustaining and spreading nutrition care improvements in hospital: qualitative interviews following an implementation study. BMJ Nutr Prev Health 2021; 4:435-446. [PMID: 35028514 PMCID: PMC8718867 DOI: 10.1136/bmjnph-2021-000281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/13/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Many patients are already malnourished when admitted to hospital. Barriers and facilitators to nutrition care in hospital have been identified and successful interventions developed; however, few studies have explored how to sustain and spread improvements. The More-2-Eat phase 1 study involved five hospitals across Canada implementing nutrition care improvements, while phase 2 implemented a scalable model using trained champions, audit and feedback, a community of practice with external mentorship and an implementation toolkit in 10 hospitals (four continuing from phase 1). Process measures showed that screening and assessment from phase 1 were sustained for at least 4 years. The objective of this study was to help explain how these nutrition care improvements were sustained and spread by understanding the role of the trained champions, and to confirm and expand on themes identified in phase 1. METHODS Semistructured telephone interviews were conducted with champions from each phase 2 hospital and recordings transcribed verbatim. To explore the champion role, transcripts were deductively coded to the 3C model of Concept, Competence and Capacity. Phase 2 transcripts were also deductively coded to themes identified in phase 1 interviews and focus groups. RESULTS Ten interviews (n=14 champions) were conducted. To sustain and spread nutrition care improvements, champions needed to understand the Concepts of change management, implementation, adaptation, sustainability and spread in order to embed changes into routine practice. Champions also needed the Competence, including the skills to identify, support and empower new champions, thus sharing the responsibility. Capacity, including time, resources and leadership support, was the most important facilitator for staying engaged, and the most challenging. All themes identified in qualitative interviews in phase 1 were applicable 4 years later and were mentioned by new phase 2 hospitals. There was increased emphasis on audit and feedback, and the need for standardisation to support embedding into current practice. CONCLUSION Trained local champions were required for implementation. By understanding key concepts, with appropriate and evolving competence and capacity, champions supported sustainability and spread of nutrition care improvements. Understanding the role of champions in supporting implementation, spread and sustainability of nutrition care improvements can help other hospitals when planning for and implementing these improvements. TRIAL REGISTRATION NUMBER NCT02800304, NCT03391752.
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Affiliation(s)
- Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
| | - Jack Bell
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Renata Valaitis
- Knowledge Development and Exchange Hub, Renison University College, Waterloo, Ontario, Canada
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
- School of Biomedical Sciences, Ulster University, Ulster, UK
- School of the Humanities and Social Sciences, University of Cambridge, Cambridge, UK
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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Bell JJ, Young AM, Hill JM, Banks MD, Comans TA, Barnes R, Keller HH. Systematised, Interdisciplinary Malnutrition Program for impLementation and Evaluation delivers improved hospital nutrition care processes and patient reported experiences - An implementation study. Nutr Diet 2021; 78:466-475. [PMID: 33817934 DOI: 10.1111/1747-0080.12663] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 01/01/2023]
Abstract
AIM Models of hospital malnutrition care reliant on dietitians can be inefficient and of limited effectiveness. This study evaluated whether implementing the Systematised, Interdisciplinary Malnutrition Program for impLementation and Evaluation (SIMPLE) improved hospital nutrition care processes and patientreported experiences compared with traditional practice. METHODS A multi-site (five hospitals) prospective, pre-post study evaluated the facilitated implementation of SIMPLE, a malnutrition care pathway promoting proactive nutrition support delivered from time of malnutrition screening by the interdisciplinary team, without need for prior dietetic assessment. Implementation was tailored to local site needs and resources. Nutrition care processes delivered to inpatients who were malnourished or at-risk of malnutrition were identified across diagnosis, intervention, and monitoring domains using standardised audits from medical records, foodservice systems and patient-reported nutrition experience measures. RESULTS Pre-implementation (n = 365) and post-implementation (n = 397) cohorts were similar for age (74 vs 73 years), gender (47.1% vs 48.6% female), and nutrition risk status (46.6% vs 45.3% at-risk). Post-implementation, at-risk participants were more likely to receive enhanced food and fluids (68.5% vs 83.9%; P < .01), nutrition information (30.9% vs 47.2%; P < .01), mealtime assistance where required (61.4% vs 77.9% P = .04), nutrition monitoring (25.2% vs 46.3%; P < .01) and care planning (17.8% vs 27.7%; P = .01). Patient-reported nutrition experience measures confirmed improved nutrition care. There was no difference in dietetic occasions of service per patient (1.51 vs 1.25; P = .83). CONCLUSIONS Tailored SIMPLE implementation improves nutrition care processes and patient reported nutrition experience measures for at-risk inpatients within existing dietetic resources.
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Affiliation(s)
- Jack J Bell
- Allied Health, The Prince Charles Hospital, Metro North HHS, Brisbane, Queensland, Australia.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Adrienne M Young
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jan M Hill
- Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Merrilyn D Banks
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Tracy A Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Rhiannon Barnes
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Heather H Keller
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada.,Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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10
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Keller H, Donnelly R, Laur C, Goharian L, Nasser R. Consensus-Based Nutrition Care Pathways for Hospital-to-Community Transitions and Older Adults in Primary and Community Care. JPEN J Parenter Enteral Nutr 2021; 46:141-152. [PMID: 33417240 DOI: 10.1002/jpen.2068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/10/2020] [Accepted: 01/05/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Practical guidance for providers on preventing, detecting, and treating malnutrition in primary care (PC) and the community is limited. The purpose of this study was to develop nutrition care pathways for adult patients (aged ≥18 years) transitioning from hospital to community and community-dwelling older adults (aged ≥65 years) who are at risk for malnutrition. METHODS A review of best-practice nutrition evidence and guidelines published between 2009 and 2019 was performed using PubMed and CINAHL. Findings were summarized into two draft care pathways by the Primary Care Working Group of the Canadian Malnutrition Task Force. Diverse stakeholders (n = 21) reviewed and suggested revisions at a 1-day meeting. Revisions were made and an online survey was conducted to determine the relevance and importance of discrete care practices, and to establish consensus for which practices should be retained in the pathways. Providers (e.g., dietitians, physicians, nurses; n = 291) across healthcare settings completed the survey. Consensus on relevance and importance of practices was set at ≥80%. RESULTS One hundred twenty-eight resources were identified and used to develop the draft pathways. Survey participants assigned ratings of ≥80% for relevance and importance for all nutrition care practices, except community service providers monitoring patient weight and appetite. CONCLUSION These evidence- and consensus-based nutrition pathways offer guidance to healthcare and service providers on how to deliver nutrition care during hospital-to-community transitions for malnourished adult patients and community-dwelling older adults at risk for malnutrition. These pathways are flexible for diverse PC and community models.
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Affiliation(s)
- Heather Keller
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2L 3G1, Canada.,Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Dr, Waterloo, Ontario, N2J 0E2, Canada
| | - Rachael Donnelly
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2L 3G1, Canada
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care and Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.,NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cowley Road, Cambridge, CB4 0WS, United Kingdom
| | - Leila Goharian
- Evergreen Community Health Centre, Vancouver Coastal Health, 3425 Crowley Dr, Vancouver, British Columbia, V5R 6G3, Canada
| | - Roseann Nasser
- Nutrition and Food Services, Pasqua Hospital, 4101 Dewdney Ave, Regina, Saskatchewan, S4T 1A5, Canada
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11
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Keller H, Koechl JM, Laur C, Chen H, Curtis L, Dubin JA, Gramlich L, Ray S, Valaitis R, Yang Y, Bell J. More-2-Eat implementation demonstrates that screening, assessment and treatment of malnourished patients can be spread and sustained in acute care; a multi-site, pretest post-test time series study. Clin Nutr 2020; 40:2100-2108. [PMID: 33077271 DOI: 10.1016/j.clnu.2020.09.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Malnutrition in medical and surgical inpatients is an on-going problem. More-2-Eat (M2E) Phase 1 demonstrated that improved detection and treatment of hospital malnutrition could be embedded into routine practice using an intensive researcher-facilitated implementation process. Yet, spreading and sustaining new practices in diverse hospital cultures with minimal researcher support is unknown. AIMS To demonstrate that a scalable model of implementation can increase three key nutrition practices (admission screening; Subjective Global Assessment (SGA); and medication pass (MedPass) of oral nutritional supplement) in diverse acute care hospitals to detect and treat malnutrition in medical and surgical patients. METHODS Ten hospitals participated in this pretest post-test time series implementation study from across Canada, including 21 medical or surgical units (Phase 1 original units (n = 4), Phase 1 hospital new units (n = 9), Phase 2 new hospitals and units (n = 8)). The scalable implementation model included: training champions on implementation strategies and providing them with education resources for teams; creating a self-directed audit and feedback process; and providing mentorship. Standardized audits of all patients on the study unit on an audit day were completed bi-monthly to track nutrition care activities since admission. Bivariate comparisons were performed by time period (initial, mid-term and final audits). Run-charts depicted the trajectory of change and qualitatively compared to Phase 1. RESULTS 5158 patient charts were audited over the course of 18-months. Admission nutrition screening rates increased from 50% to 84% (p < 0.0001). New Phase 1 units more readily implemented screening than Phase 2 sites, and the original Phase 1 units generally sustained screening practices from Phase 1. SGA was a sustained practice at Phase 1 hospitals including in new Phase 1 units. The new Phase 2 units improved completion of SGA but did not reach the levels of Phase 1 units (original or new). MedPass almost doubled over the time periods (7%-13% of all patients p < 0.007). Other care practices significantly increased (e.g. volunteer mealtime assistance). CONCLUSION Nutrition-care activities significantly increased in diverse hospital units with this scalable model. This heralds the transition from implementation research to sustained changes in routine practice. Screening, SGA, and MedPass can all be implemented, improve nutrition care for all patients, spread within an organization, and for the most part, sustained (and in the case of original Phase 1 units, for over 3 years) with champion leadership.
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Affiliation(s)
- Heather Keller
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON N2J 0E2, Canada; Department of Kinesiology, University of Waterloo, Canada.
| | | | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; NNEPro Global Centre for Nutrition and Health in Cambridge, Cambridge, UK
| | - Helen Chen
- School of Public Health and Health Systems, University of Waterloo, Canada
| | - Lori Curtis
- Department of Economics, University of Waterloo, Canada
| | - Joel A Dubin
- School of Public Health and Health Systems and Department of Statistics and Actuarial Science, University of Waterloo, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Canada
| | - Sumantra Ray
- School of Humanities and Social Sciences, University of Cambridge, Cambridge, UK; NNEPro Global Centre for Nutrition and Health in Cambridge, Cambridge, UK; School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Renata Valaitis
- School of Public Health and Health Systems, University of Waterloo, Canada
| | - Yang Yang
- School of Public Health and Health Systems, University of Waterloo, Canada
| | - Jack Bell
- School of Human Movement and Nutrition Sciences, The University of Queensland, Australia; The Prince Charles Hospital, Australia
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Brooks M, Vest MT, Shapero M, Papas M. Malnourished adults’ receipt of hospital discharge nutrition care instructions: a pilot study. J Hum Nutr Diet 2019; 32:659-666. [DOI: 10.1111/jhn.12662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- M. Brooks
- Christiana Care Value Institute Newark DE USA
| | - M. T. Vest
- Department of Medicine Christiana Care Health System Christiana Care Value Institute Newark DE USA
- Sidney Kimmel Medical College Philadelphia PA USA
| | - M. Shapero
- Department of Food and Nutrition Services Christiana Care Health System Newark DE USA
| | - M. Papas
- Christiana Care Value Institute Newark DE USA
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