Impact of Nutrition Screening on Patient Care

Abstract

A nutrition screening program was initiated to provide early identification of patients who might benefit from nutrition intervention. All patients were screened within 72 hours of admission. Four indicators were used to determine nutritional risk 1) serum albumin or prealbumin 2) current weight as percent desirable body weight 3) percent of meals consumed or nutrition support by tube feeding (TF) or total parenteral nutrition (TPN) in patients who were not being monitored by the nutrition support service and 4) admission diagnosis of malnutrition. A total of 532 patient records were reviewed in a case control study. Cases were 266 screened adult patients admitted from August 1992 through January 1993 for whom complete medical records were available. Controls (unscreened patients) were 266 patients admitted from August 1991 through January 1992. Cases and controls were matched for primary diagnosis related group (DRG), age and sex. Length of stay ranged from four days to 38 days, with a mean length of stay of 7.15 ± 4.04 days in unscreened patients and 7.31 ± 4.05 days in screened patients. Nutrition screening doubled the number of days in which patients at nutritional risk received nutritional snacks (p<.03). There were no differences in the number of patient days on TF or TPN. The number of patient contacts by a registered dietitian (RD) and/or dietetic technician (DTR), expressed as percent of days in the hospital, was significantly increased (p<.001) in screened patients (27.44 ± 20.14) compared to unscreened patients (12.15 ±22.55). The number of patients contacted by an RD or DTR prior to the fourth day of admission was 54/266 (20.3%) in screened cases compared to 26/266 (9.8%) in unscreened controls (p<.003). The study suggests that a screening program in which all patients are screened for nutritional risk within 72 hours of admission can optimize the delivery of nutritional services.