Targeted Physician Education Positively Affects Delivery of Nutrition Therapy and Patient Outcomes |
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| Authors: | Ryan T. Hurt MD PhD Stephen A. McClave MD David C. Evans MD Chris Jones MD Keith R. Miller MD Thomas H. Frazier MD Mahad A. Minhas MPH Cynthia C. Lowen RD Allyson Stout RD Jithinraj Edakkanambeth Varayil MD Paul J. Matheson PhD Glen A. Franklin MD |
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| Affiliation: | 1. Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota;2. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota;3. Division of Endocrinology, Mayo Clinic, Rochester, Minnesota;4. Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky;5. Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky;6. Department of Surgery, The Ohio State University, Columbus, Ohio;7. Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky |
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| Abstract: | 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. |
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| Keywords: | enteral nutrition nutrition nutrition support teams nutrition support practice outcomes research/quality |
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