Targeted Physician Education Positively Affects Delivery of Nutrition Therapy and Patient Outcomes: Results of a Prospective Clinical Trial.

BACKGROUND: Malnutrition is a continuing epidemic among hospitalized patients. We hypothesize that targeted physician education should help reduce caloric deficits and improve patient outcomes. MATERIALS AND METHODS: We performed a prospective trial of patients (n = 121) assigned to 1 of 2 trauma groups. The experimental group (EG) received targeted education consisting of strategies to increase delivery of early enteral nutrition. Strategies included early enteral access, avoidance of nil per os (NPO) and clear liquid diets (CLD), volume-based feeding, early resumption of feeds postprocedure, and charting caloric deficits. The control group (CG) did not receive targeted education but was allowed to practice in a standard ad hoc fashion. Both groups were provided with dietitian recommendations on a multidisciplinary nutrition team per standard practice. RESULTS: The EG received a higher percentage of measured goal calories (30.1 ± 18.5%, 22.1 ± 23.7%, P = .024) compared with the CG. Mean caloric deficit was not significantly different between groups (-6796 ± 4164 kcal vs -8817 ± 7087 kcal, P = .305). CLD days per patient (0.1 ± 0.5 vs 0.6 ± 0.9), length of stay in the intensive care unit (3.5 ± 5.5 vs 5.2 ± 6.8 days), and duration of mechanical ventilation (1.6 ± 3.7 vs 2.8 ± 5.0 days) were all reduced in the EG compared with the CG (P < .05). EG patients had fewer nosocomial infections (10.6% vs 23.6%) and less organ failure (10.6% vs 18.2%) than did the CG, but these differences did not reach statistical significance. CONCLUSION: Implementation of specific educational strategies succeeded in greater delivery of nutrition therapy, which favorably affected patient care and outcomes.

Physician-delivered malnutrition: why do patients receive nothing by mouth or a clear liquid diet in a university hospital setting?

BACKGROUND: Traditional practices of placing patients nil per os (NPO) or on clear liquid diet (CLD) deter delivery of optimal nutrition care and are not always supported by sound physiologic principles. OBJECTIVE: This perspective survey evaluated the incidence of this practice, the reasons for such orders, and the response to intervention by the Multidisciplinary Nutrition Team (MNT). METHODS: All patients admitted to University of Louisville Hospital were monitored by MNT dietitians and were candidates for the study if they were placed NPO upon CLD for ≥ 3 days. The MNT determined appropriateness of diet orders. RESULTS: Out of 1192 admissions, 22.6% of the patients (n = 262, 61% male, mean age 46.1 years) were found to be NPO or on CLD for ≥ 3 days (mean 5.2 days NPO, 1.04 days CLD), and were entered in the study. Uncertainty regarding the reason for the specific diet order occurred more often when patients were placed on CLD than when made NPO (32.1% vs. 15.0% of cases, respectively, P < 0.05). NPO diet orders were more often deemed appropriate by the MNT than were orders for CLD (58.6% vs. 25.6%, respectively, P < 0.05). Compliance with MNT recommendations was low at 40.0%. CONCLUSIONS: Despite an active MNT, 22% of patients were made NPO or placed on CLD for a prolonged period of time. More than a third of diet orders for NPO and two thirds of orders for CLD were inappropriate and poorly justified. Improving the adequacy of nutrition therapy is hampered by noncompliance with MNT recommendations.