Hospital nutrition may soon be getting some major recognition as a key player in better patient outcomes. Nestle Health Science has just launched a free web-based integrated nutrition program called ENact, which will allow hospitals to develop and implement nutrition quality improvement (QI) projects.
Evidence-based literature shows that malnutrition is not uncommon in the hospital setting. "More than 50 percent of patients are malnourished," Dr. Matthew Bechtold, associate professor of clinical medicine at the University of Missouri and a gastroenterologist, told Healthcare Dive. According to ENact, malnourished patients are 3.4 times more likely to have major complications, spend 2.3 days longer in the hospital and cost $4,734 more per stay.
"There is a systematic way of doing this—the PDSA cycle—which is Plan, Do, Study, Act," Bechtold said. "This enables you to have a systematic way to improve your institution toward an ultimate goal of improving patient care."
Brechtold said the platform can be used in any institution and is designed to give users the tools necessary to make changes. "Let's face it: Every system can be improved, no matter how good you think it is," he added.
Research results have shown that nutrition helps reduce complication risks, hospital length of stays and care costs for decades, yet it continues to be undervalued in the clinical setting. However, with increasing value-based reimbursement policies going live, healthcare outcomes are now a high priority, placing more pressure on hospitals.
The program is already underway at some institutions: Bechtold said his group is using the basics of the ENact platform.
"We're going to have quite a few QI programs at the University of Missouri, trying to improve the overall caloric intake of our patients and reduce NPO (nothing by mouth) times. We've already started that and it's getting good results."
ENact provides a tutorial on how to implement quality improvement.
"That's the biggest thing—people want to improve quality, but they’re not exactly sure how to do it. That's a big problem around the country," Bechtold said. "I think what happens is you have experts tell you how to do it, but it gets intimidating with all the tools and the process. ENact allows people to learn the process and language of quality improvement and apply it to the nutritional site in their own institutions."
There are three main sections to the website: Learn, Act and Connect. The Learn section includes resources on what quality improvement is and how it works. It also contains QI tools such as downloadable templates that institutions can print out and use. Examples of nutrition QI projects are provided for potential ideas.
Act provides sample structure projects for high-risk populations that can be modified for specific goals. Resources include three toolkits: one for optimizing protein delivery in the ICU, a malnutrition toolkit for enhancing oral nutrition supplementation compliance and a surgery toolkit for addressing pre-operative nutritional care.
The Connect section includes a list of resources, such as the Institute for Healthcare Improvement, to support continuous involvement with the QI process and an email sign-up option to receive ENact news and updates from the company.
Benefits of quality improvement
One of the advantages of QI, according to Dr. Bechtold, is that an institute can change things quickly by doing different PDSA cycles to make things better. This is much faster than randomized control trials, which can take years to design and conduct and a year or more to publish results.
"Nutrition is an area where we can definitely see some quick benefits and get our patients feeling better, with fewer complications, shorter hospital stays, and lower costs," he explained. In addition, QI can be applied to any institution and is not restricted to nutrition.
"This is a huge benefit for providers. With that in mind, ENact may play a vital role in defining quality improvement initiatives throughout the country with the result being the enhancement of patient care in all facets of the hospital," he said.
QI projects can also improve patient quality of life. Nutrition is especially important for the elderly population. Research shows that those who are malnourished stay in the hospital longer and become de-conditioned, resulting in longer rehabilitation times. "If you can keep the elderly nourished while in the hospital, you can decrease length of the hospital stay because of fewer complications and potential infections, so the sooner we can get people out with the proper nutrition, the sooner they can get into rehab and back to their daily living," Bechtold said.