Nutritional Intervention Can 
               Improve Hospital Patients' 
               Outcome, Reduce Costs 
               The Hospitalist. 2013 July;2013(7) 
               Author(s):  
                       Maybelle Cowan-Lincoln 
                                                                 
                                                                 
                                                                 
                                                                 
                                                                 
                                                                 
                                                             Dr. Tappenden
                                                                      
               Three Steps to Better Nutrition 
               Hospitalists should consider these steps to improve patient nutritional care: 
               1. Recognize malnourished patients and those at risk for malnutrition: 
                   •   Screen all patients for malnutrition promptly. 
                   •   Use an accepted, validated screening tool. 
               2. Implement comprehensive nutritional interventions: 
                   •   Take a multidisciplinary approach that includes dietitians, nurses, and family 
                       members. 
                         •    Rescreen throughout hospital stay to monitor progress. 
                    3. Develop a comprehensive discharge nutritional plan: 
                         •    Make nutrition part of conversations with patients, family members, and 
                              caregivers. 
                         •    Reinforce the importance of nutrition as part of care at home. 
                    Health-care reform is on everyone’s mind these days, and SHM, along with numerous 
                    other groups, believes some reform goals can be achieved through the stomach. 
                    Data show an effective program of nutritional intervention during a patient’s hospital 
                    stay can go a long way toward improving patient outcomes and reducing 
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                    costs. Hospitalists, however, often have little formal nutrition training. A 
                    multidisciplinary approach to patient nutrition that brings together multiple 
                    stakeholders—hospitalists, nurses, and dietitians—might effectively address this need 
                    with a team tactic, according to Melissa Parkhurst, MD, medical director of the hospital 
                    medicine section at the University of Kansas Medical Center in Kansas City.1 
                    Between 20% and 50% of inpatients suffer from malnutrition.2 Many patients, especially 
                    the elderly, are malnourished on admission. Many more become malnourished within a 
                    few days of their hospital stay due to NPO orders and the effects of disease on 
                    metabolism.2 Malnutrition has been associated with worsened discharge status, longer 
                    length of stay, higher costs, and greater mortality, as well as increased risk of:2 
                         •    Nosocomial infections; 
                         •    Falls; 
                         •    Pressure ulcers; and 
                         •    30-day readmissions. 
                                     
                    Dr. Tappenden 
                    To address malnutrition prevalence and its detrimental effects, SHM and the Academy 
                    of Medical-Surgical Nurses (AMSN), the Academy of Nutrition and Dietetics (AND), the 
                    American Society of Parenteral and Enteral Nutrition (ASPEN), and Abbott Nutrition 
                    have formed the Alliance for Patient Nutrition. Kelly Tappenden, MD, PhD, professor of 
                    food science and human nutrition at the University of Illinois at Urbana, says the 
                    alliance aims to raise awareness of the impact nutrition can have on patient outcomes 
                    (see “Three Steps to Better Nutrition,” below). 
                    The campaign is being initiated with the publication of a consensus paper in several 
                    peer-reviewed journals. A baseline survey will be conducted among professionals 
       represented in the alliance to assess their familiarity with the prevalence of malnutrition 
       in a hospital setting. The next step is to foster this change in patient care by providing 
       resources on the alliance’s website (www.malnutrition.com), including malnutrition 
       screening tools, a toolkit to facilitate multidisciplinary collaboration, and continuing 
       medical education (CME) information. 
            
       Dr. Parkhurst 
       As a founding member of the alliance, SHM is communicating this message to its 
       members, encouraging hospitalists to lead the way in transforming hospital culture to 
       recognize the critical role nutrition plays in patient care. 
       “Nutrition matters,” Dr. Parkhurst says. “You can be winning the battle and losing the 
       war if you are not paying attention to patient nutrition.” 
       Team Approach 
            
       Dr. Quatrara 
       Beth Quatrara, DNP, RN, director of the nursing research program at the University of 
       Virginia Health System in Charlottesville and nursing spokesperson for the alliance, 
       says several shortcomings can be identified in the nutritional care U.S. hospitals provide 
       from admission through discharge and beyond. For example, the Joint Commission 
       requires that all patients be screened for malnutrition risk within 48 hours of admission. 
       But screening is often as cursory as looking at the patient and deciding that he or she 
       “looks fine.” Diets often are set for patients with no thought to taste, texture, or cultural 
       preferences, or even to such practical matters as ascertaining whether the patient has 
       dentures, Quatrara says. Meal trays are left when patients are out of their rooms for 
       procedures and retrieved by dietary staff before patients return. And except for calorie 
       count orders, accurate records often are not kept of actual food consumption. 
       The alliance, which is made possible with support from Abbott's nutrition business, 
       recommends that physicians implement a three-step plan to improve patient outcomes. 
       The approach begins with an evaluation of a patient’s nutritional status on admission 
       using a simple, validated screening tool, such as the Malnutrition Screening Tool. When 
       an at-risk status is determined, a more in-depth screening is performed. “When patients 
       at risk for malnutrition can be identified faster, appropriate interventions can be put 
       into place sooner,” Quatrara says. 
               The second step is nutrition intervention with a personalized nutritional care plan that 
               takes into account the individual’s health conditions, caloric needs, physical limitations, 
               tastes, and preferences. An interdisciplinary team approach can transform hospital 
               nutrition, bringing together hospitalists, nurses, nursing assistants, registered dietitians, 
               and the dietary staff to collaboratively develop a nutrition care plan that will be central 
               to patient’s overall treatment, Dr. Tappenden says. 
               “There is a science behind nutrition and metabolic care,” Dr. Tappenden says. “Just like 
               any other aspect of patient care, we can’t just throw out a blanket solution.” 
               But nutritional care cannot stop with developing this plan at the outset. Patients must 
               be rescreened throughout their time at the hospital to measure any changes in 
               nutritional status due to disease progression or treatment success. 
               For optimal impact, all members of the nutritional care team—nurses, nursing 
               assistants, dietary support staff, and family members—should take responsibility for an 
               essential component of the patient’s care: tracking and reporting consumption to the 
               physician to open a dialogue about balancing an individual’s needs with tastes and 
               preferences. 
               The hospitalist’s final step is developing a discharge plan that includes nutrition care 
               and education so that patients, families, and caregivers can implement better nutrition 
               at home. 
               “Nutrition makes sense,” Dr. Tappenden says. “Everything we are working toward in 
               healthcare reform can be achieved by taking more care to make nutrition part of the 
               solution.” 
               Maybelle Cowan-Lincoln is a freelance writer in New Jersey.                                        
               Studies Show Nutrition Matters 
               Malnutrition can adversely affect patient outcomes: 
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                   •   Malnourished patients are twice as likely to develop a pressure ulcer.  
                   •   Patients with malnutrition/weight loss have 2.5 times the risk for surgical-site 
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                       infections (SSIs).  
               Studies demonstrate nutritional intervention benefits inpatients: 
                   •   Can help reduce readmissions by 28%.8 
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                   •   Helps reduce risk of falls in malnourished patients.  
                   •   Can reduce hospital LOS by an average of two days.3