Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA.
JPEN J Parenter Enteral Nutr. 2013 Jul;37(4):482-97. doi: 10.1177/0148607113484066. Epub 2013 Jun 4.
The current era of healthcare delivery, with its focus on providing high-quality, affordable care, presents many challenges to hospital-based health professionals. The prevention and treatment of hospital malnutrition offer a tremendous opportunity to optimize the overall quality of patient care, improve clinical outcomes, and reduce costs. Unfortunately, malnutrition continues to go unrecognized and untreated in many hospitalized patients. This article represents a call to action from the interdisciplinary Alliance to Advance Patient Nutrition to highlight the critical role of nutrition intervention in clinical care and to suggest practical ways to promptly diagnose and treat malnourished patients and those at risk for malnutrition. We underscore the importance of an interdisciplinary approach to addressing malnutrition both in the hospital and in the acute posthospital phase. It is well recognized that malnutrition is associated with adverse clinical outcomes. Although data vary across studies, available evidence shows that early nutrition intervention can reduce complication rates, length of hospital stay, readmission rates, mortality, and cost of care. The key is to systematically identify patients who are malnourished or at risk and to promptly intervene. We present a novel care model to drive improvement, emphasizing the following 6 principles: (1) create an institutional culture where all stakeholders value nutrition, (2) redefine clinicians' roles to include nutrition care, (3) recognize and diagnose all malnourished patients and those at risk, (4) rapidly implement comprehensive nutrition interventions and continued monitoring, (5) communicate nutrition care plans, and (6) develop a comprehensive discharge nutrition care and education plan.
在当前的医疗保健服务时代，关注提供高质量、负担得起的医疗服务，这给医院内的医疗保健专业人员带来了许多挑战。预防和治疗医院营养不良为优化患者整体护理质量、改善临床结果和降低成本提供了巨大机会。不幸的是，许多住院患者的营养不良仍然未被识别和治疗。本文代表了推进患者营养跨学科联盟的行动呼吁，强调营养干预在临床护理中的关键作用，并提出了及时诊断和治疗营养不良患者和有营养不良风险患者的实用方法。我们强调了在医院和急性出院后阶段解决营养不良问题的跨学科方法的重要性。众所周知，营养不良与不良临床结果有关。尽管研究数据各不相同，但现有证据表明，早期营养干预可以降低并发症发生率、住院时间、再入院率、死亡率和医疗成本。关键是系统地识别营养不良或有风险的患者并及时进行干预。我们提出了一种新的护理模式来推动改进，强调以下 6 个原则：（1）创建一种所有利益相关者都重视营养的机构文化，（2）重新定义临床医生的角色，包括营养护理，（3）识别和诊断所有营养不良患者和有风险的患者，（4）迅速实施全面的营养干预和持续监测，（5）沟通营养护理计划，以及（6）制定全面的出院营养护理和教育计划。
