This research area focuses on improving the nutrition care processes and food intake of patients in hospital and through their transitions back into the community. Current research projects include, More-2-Eat, which involves implementation of the Integrated Nutrition Pathway for Acute Care in five hospitals to improve diets among frail older adults. This implementation project will not only demonstrate that the pathway is feasible, from a personnel and resource perspective, but also that patient reported outcomes, such as food intake, barriers to food intake, and quality of life are improved with this pathway. Implementation involves family, patient and staff education on the importance of nutrition to recovery as well as changing care processes in the hospital so that malnutrition is prevented, identified and treated. The Canadian Malnutrition Task Force is an important partner in this work.
Malnutrition’s effect on length of stay in hospital
Malnutrition’s effect on length of stay in hospital
Study title
Malnutrition at hospital admission-contributors and effect on length of stay: A prospective cohort study from the Canadian Malnutrition Task Force.
The study
Between 2010 and 2013, the Canadian Malnutrition Task Force (CMTF) took on a three year in-depth study called Nutrition Care in Canadian Hospitals (NCCH). The goal of NCCH was to see how often malnutrition occurs in Canadian hospitals and in what specific ways it affects patients. 1,022 patients participated in this research study recruited from 18 hospitals across the country.
What was found
- The best available diagnostic test called the subjective global assessment (SGA) showed that 45% of adults admitted to hospital were malnourished.
- Malnutrition upon hospital admission independently predicted length of stay (LOS).
- Patients that entered hospital well-nourished but had poor food intake during their admission, stayed on average 6 days longer than well-nourished patients who ate their meals.
- Similarly, malnourished patients who improved throughout their admission stayed one day less than their equivalents who did not improve.
- Longer LOS was also predicted by patients eating less than 50% of the food given to them in their first week.
- With the current in-hospital process that leads to a dietitian consult, 75% of malnourished patients were missed.
Steps for improvement
- Nutrition screening at admission followed by efficient and timely diagnosis and treatment is needed to promote nutrition care.
- The whole health care team and the family have a role to play in supporting nutrition while in hospital.
- Better monitoring and interventions to support food intake are needed.
- To ensure referral to Registered Dietitians who are the specialists, check at the below website for care pathway tips.
Authors
Johane Allard, Heather Keller, Khursheed Jeejeebhoy, Manon Laporte, Don R. Duerkson, Leah Gramlich, Hélène Payette, Paul Bernier Elisabeth Vesnaver, Bridget Davidson, Anastasia Teterina, and Wendy Lou.
Find valid resources such as screening and assessment tools and the full-text article for more information.
ARTICLE SUMMARY: Malnutrition at hospital admission-contributors and effect on length of stay: A prospective cohort study (PDF)
Physician perceptions of nutrition care
Physician perceptions of nutrition care
Study title
Physicians’ Perceptions Regarding the Detection and Management of Malnutrition in Canadian Hospitals: Results of a Canadian Malnutrition Task Force Survey.
The study
Surveys were filled out by physicians at 18 Canadian hospitals to collect their thoughts about nutrition care of patients in hospitals. Their answers were then analyzed for content according to hospital and unit type. 428 total surveys were completed by physicians and then analyzed by the study team.
What was found
- Physicians feel that there is a difference between what is being done to care for hospital patient malnutrition and the best known standard for care.
- Physicians felt that the health care team’s knowledge could be improved. They believed that this was important because although their nutrition knowledge is limited, physicians know that prevention of hospital-associated malnutrition is an important part of the care which they provide.
| Stage in Hospital Stay | Percentage of Physicians Who Believe Nutritional Assessment … | |
|---|---|---|
| Should Be Done at This Point | Is Actually Done at This Point | |
| At Admission |
87% |
33% |
| During Stay |
86% |
41% |
| When Discharged |
78% |
29% |
- Physician interest in nutrition is greater than their knowledge when self-assessed on a scale of 1 to 10.
What can be done
- A complete team of professionals is needed to best treat in-hospital malnutrition.
- Further education targeted at physicians to improve their nutrition knowledge.
Authors
Donald R. Duerksen, Heather H. Keller, Elisabeth Vesnaver, Johane P. Allard, Paule Bernier, Leah Gramlich, Hélène Payette, Manon Laporte, and Khursheed Jeejeebhoy.
Find the full-text article for more information.
Nurses’ thoughts on malnutrition
Nurses’ thoughts on malnutrition
Study title
Nurses’ perceptions regarding the prevalence, detection, and causes of malnutrition in Canadian hospitals: Results of a Canadian Malnutrition Task Force Survey.
The study
346 surveys were completed by nurses from 11 hospitals participating in the Canadian Malnutrition Task Force. The participating nurses worked in surgical and medical areas. Nurses were chosen as survey participants because they are often the first point of contact for patients when they are admitted into hospital. This means that they have a unique opportunity to identify patients at risk for malnutrition and to refer for a more detailed assessment if necessary.
What was found
- Over 50% of nurses underestimated how often malnutrition occurs
- Nurses considered identifying malnourished patients to be a priority (8.4/10 importance).
- 95.5% of nurses would want to use a 3-question system to identify these patients.
- Nurses wanted to gain more nutrition information (92% of them) however only some (39%) said they had access to it.
- Nurses felt that a nutrition assessment should be completed on admission (94% of nurses) but only 67% felt that it was done for more than half of patients.
Steps to improve
- Accessible nutrition education for nurses.
- Implement a malnutrition screening policy for nurses.
- Connect hospital nutrition policy with nurses’ roles.
- Increase the emphasis on nutrition in nursing curriculums.
- Address the lack of eating help available to patients (as suggested by nurses).
- Concrete definitions of roles for all members of the health care team.
Authors
Donald R. Duerksen, Heather H. Keller, Elisabeth Vesnaver, Manon Laporte, Khursheed Jeejeebhoy, Hélène Payette, Leah Gramlich, Paule Bernier, and Johane P. Allard.
Find the full-text article for more information.
Predicting malnutrition: Nutrition indicators
Predicting malnutrition: Nutrition indicators
Study title
Nutritional assessment: Comparison of clinical assessment and objective variables for the prediction of length of hospital stay and readmission.
The study
733 admitted patients in 18 hospitals spanning eight Canadian provinces were assessed with various Nutrition Indicators (NIs) to identify malnutrition. The length of hospital stay was recorded as well as whether the person we readmitted within 30 days after their original stay. The goal was to compare how well each of the NIs predicted these two outcomes. Both length of stay and 30 day readmission have been linked to malnutrition in prior research.
Nutrition Indicators (NIs) that were used during admission:
- Subjective Global Assessment (SGA): A comprehensive standardized assessment to diagnose malnutrition
- Nutrition Risk Screening: A scored questionnaire with questions about nutrition
- Body weight
- Mid-arm and calf circumference
- Serum albumin: Crucial protein found in the blood
- Handgrip strength (HGS)
- Food intake during the first week of hospitalization
What was found
Other factors such as age, sex, and diagnosis were considered and accounted for. The following factors were significant:
- Handgrip strength (HGS)a,b
- Subjective Global Assessment (SGA)a,b
- Food intake in first weeka
*a=predictors of length of hospital stay; b=predictors of 30 day readmission.
Action to take
SGA should be used as the single best assessment of malnutrition at admission. HGS may add important information and can be readily done at admission, however food intake during hospitalization can only be used to predict outcomes during the course of hospitalization.
Authors
Khursheed Jeejeebhoy, Heather H. Keller, Leah Gramlich, Johane P. Allard, Manon Laporte, Donald R. Duerksen, Hélène Payette, Elisabeth Vesnaver, Bridget Davidson, Anastasia Teterina, and Wendy Lou.
Find the full-text article for more information.
Food intake challenges in hospitals
Food intake challenges in hospitals
Study title
Barriers to food intake in acute care hospitals: A report of the Canadian Malnutrition Task Force.
The study
A valid questionnaire was given to 890 participating patients at 18 hospitals throughout Canada. The goal was to receive their opinions about barriers and challenges to food intake while in hospital. This study was done in order to find possible solutions for low food intake during an acute care hospital stay, which can worsen already present malnutrition.
What was found
- Listed from the most to least common, are barriers to food intake as noted by patients in this study:
- Loss of appetite (63.9%)
- Not being given food when a meal was missed (69.2%)
- Not wanting ordered food (58%)
- Feeling too sick to eat (42.7%)
- Being interrupted at meals (41.8%)
- Being too tired to eat (41.1%)
- Younger patients were more likely than older people to be disturbed at meals and miss meals for tests.
- Certain groups were more likely to experience many barriers of varying types. These patients were:
- Malnourished
- Women
- Experiencing several medical conditions
- Eating less than half of their meals
Action to take
Consider looking for and resolving the barriers to food intake listed above as a way to improve food intake of patients in hospital.
Authors
Heather H. Keller, Johane P. Allard, Elisabeth Vesnaver, Manon Laporte, Leah Gramlich, Paule Bernier, Bridget Davidson, Donald R. Duerksen, Khursheed Jeejeebhoy, and Hélène Payette.
Find the full-text article for more information.
Factors that influence obtaining a dietary consult
Factors that influence obtaining a dietary consult
Study title
Predictors of dietitian consult on medical and surgical wards.
The study
The goal of this study was to assess what factors lead to the hospital health care team obtaining a dietitian consult (DC) for a patient. 947 patients who consumed their nutrition via regular food were participants. Patients were from the medical and surgical wards of 18 different Canadian hospitals. They were assessed with several tools: subjective global assessment (SGA) to determine malnutrition, body mass index, patient demographics, dietary intake, and presence of a DC. The main comparison was between obtaining a DC within three days or within four or greater days.
What was found
- Moderate to severe malnutrition was found in 45% of participants.
- Dietitians were consulted for 23% of patients. From these patients:
- 44% were well nourished
- 37% were mildly/moderately malnourished
- 19% were severely malnourished
- DC missed out on 75% of the moderately and severely malnourished patients
|
Predictors of consultation within…. |
|
|---|---|
|
3 days |
4 + days |
|
|
Steps to improve
- Care must be taken not to miss the following vulnerable populations who could benefit from a dietitian consult:
- Patients with malnutrition (moderate or severe scores on the SGA).
- Patients eating less than half of their meals
Authors
Heather H. Keller, Johane P. Allard, Manon Laporte, Bridget Davidson, Hélène Payette, Paule Bernier, Khursheed Jeejeebhoy, Donald R. Duerksen, and Leah Gramlich.
Find the full-text article for more information.
ARTICLE SUMMARY: Predictors of dietitian consult on medical and surgical wards (PDF)
Nutrition care professionals review hospital nutrition
Nutrition care professionals review hospital nutrition
Study title
Providing quality nutrition care in acute care hospitals: Perspectives of nutrition care personnel.
The study
This study had the goal of obtaining details on challenges to food intake and nutrition and good processes that acute care hospitals have in place that promote the recovery of patients.
91 nutrition care professionals from 8 Canadian hospitals participated in focus groups.
These 8 hospitals were a part of the broader Nutrition Care in Canadian Hospitals (NCCH) study.
Nutritional care professionals included; dietitians, dietetic interns, diet technicians, and menu clerks.
What was found
Five key themes about what quality nutrition requires came from the focus group discussions:
- A nutrition culture which highly values the role of nutrition practice in patient recovery, with teams working together to reach nutrition goals.
- Effective tools, such as screening tools, protocols based on valid research, and quality food.
- An effective communication network for food service systems to support delivery of care.
- Responsiveness to care needs, such as a flexible food service system, appropriate meals or supplements, as well as accurate and up to date clinical care.
- Clear definition and separation of roles; the right person doing the right job.
Authors
Heather H. Keller, Elisabeth Vesnaver, Bridget Davidson, Johane P. Allard, Manon Laporte, Paule Bernier, Hélène Payette, Khursheed Jeejeebhoy, Donald R. Duerksen, and Leah Gramlich.
Find the full-text article for more information.
