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May 06 2013
The Critical Role Hospitalists Can Play to Combat Patient Malnutrition
By: Melissa Parkhurst, MD

Every day we witness the debilitating impact malnutrition has on our patients. With as many as 1 in 3 patients entering the hospital malnourished1-3, physicians and other healthcare providers must understand the adverse effects malnutrition has on patient outcomes, length of stay and overall treatment costs. With the implementation of the Patient Protection and Affordable Care Act, a significant and urgent emphasis is being placed upon the importance of improving quality of patient care and cutting expenditures. This creates a unique opportunity for hospitals to elevate the role nutrition plays in enhancing health outcomes for patients.

One of the most critical aspects to comprehensively identify and treat patient malnutrition is to drive interdisciplinary collaboration among dietitians, nurses, hospitalists and other physicians. A significant part of The Alliance to Advance Patient Nutrition is to facilitate greater collaboration among clinicians at hospitals across the country. A key first step to ensure that patient nutrition treatment is properly implemented is to establish a nutrition support team or a similar model. The nutrition support team creates a clear framework that hospitals can systematically incorporate and work from when addressing patient nutrition needs.

At my hospital, the University of Kansas Medical Center (UKMC), we have made significant strides in integrating a higher degree of communication and collaboration among clinicians from a variety of disciplines by establishing a nutrition support team. For instance, I serve as the Medical Director of the Nutrition Support Service, working with five team members – including registered dietitians, pharmacists and nurses – who are all board certified in clinical nutrition support. It is my duty to oversee the daily nutrition management of adult hospitalized patients. This collaborative team effort has yielded tremendous progress in better identifying and treating malnutrition. I strongly believe that if this type of interdisciplinary approach is established from the outset, clinicians and hospital administrators will be much better equipped to establish clear protocols and practices that enable more effective nutrition treatment in the hospital and formulate pragmatic discharge planning. When done properly, this can help to reduce unnecessary readmissions, which, in effect, will lead to significant cost reductions.

In addition to instituting higher degrees of interdisciplinary collaboration and nutrition support teams, hospitals must ensure that appropriate screening tools are in place to properly identify malnourished patients. Given the prevalence of patient malnutrition, physicians and other clinicians must recognize and intervene with appropriate screening tools and care, irrespective of their age, weight or outward appearance.

It is important for hospitals to recognize that a ‘one-size-fits-all’ paradigm does not work effectively. Certainly, each hospital possesses unique attributes that necessitate tailored approaches. Hospital administrators will need to evaluate the costs associated with the allocation of staff and the requisite training. Importantly, every hospital should strive to develop a multidisciplinary nutritional support team that fits their needs, organizational culture, and personnel budget. While this can be challenging, it can provide critical benefits that enhance the quality of care, improve clinical outcomes and reduce costs.

1Coats KG et al.. J Am Diet Assoc 1993; 93: 27-33.
2Giner M et al. Nutrition 1996; 12: 23-29.
3Thomas DR et al.Am J Clin Nutr 2002; 75: 308-313.