Sharma Yogesh, Miller Michelle, Shahi Rashmi, Hakendorf Paul, Horwood Chris, Thompson Campbell
Consultant Physician, Department of General Medicine, Flinders Medical Centre, South Australia and Senior Lecturer, School of Medicine, Flinders University, South Australia.
Professor, Nutrition & Dietetics Department, Flinders University, South Australia.
Br J Nurs. 2016 Oct 13;25(18):1006-1014. doi: 10.12968/bjon.2016.25.18.1006.
The rate of malnutrition among hospitalised elderly patients in Australia is 42.3%. Malnutrition is known to lead to significant adverse outcomes for the patients and increase hospital costs through increased use of resources.
This study assessed nutrition screening adequacy and investigated factors associated with missed opportunity to diagnose malnutrition.
A prospective cross-sectional study involving 205 general medical patients aged ≥60 years admitted acutely in a tertiary hospital over a period of 1 year. Patients who were not given initial nutritional screening were noted and all patients underwent nutritional assessment. The researchers assessed demographic data and performed univariate analysis of factors responsible for missed nutritional screening.
Only 99 patients (49.5%) were screened for malnutrition and 100 (50.3%) missed initial nutritional screening (data incomplete for 6 patients). Of those screened, more were malnourished (n=64; 61.5%) than those not screened (n=40; 38.5%), p<0.001. There was no significant difference in screening rates over the weekends and public holidays compared with weekdays (p=0.14). Time of day (p=0.03) and ward location (p=0.001) were significant factors, which determined nutrition screening.
This study indicates common associations that might explain low inpatient screening rates for malnutrition; these include apparently adequate nutritional status, lower staff to patient ratios and outlier ward locations. Ensuring consistent nutrition screening with appropriate therapeutic interventions for patients and educational interventions for staff could pay dividends not only in terms of improved patient health but also in terms of hospital reimbursement.
澳大利亚住院老年患者的营养不良发生率为42.3%。众所周知，营养不良会给患者带来严重不良后果，并因资源使用增加而提高医院成本。
本研究评估营养筛查的充分性，并调查与营养不良诊断错失机会相关的因素。
一项前瞻性横断面研究，涉及一家三级医院在1年期间急性收治的205名年龄≥60岁的普通内科患者。记录未进行初始营养筛查的患者，并对所有患者进行营养评估。研究人员评估了人口统计学数据，并对导致营养筛查遗漏的因素进行了单因素分析。
仅99名患者（49.5%）接受了营养不良筛查，100名患者（50.3%）错失了初始营养筛查（6名患者数据不完整）。在接受筛查的患者中，营养不良的患者（n = 64；61.5%）比未接受筛查的患者（n = 40；38.5%）更多，p<0.001。与工作日相比，周末和公共假日的筛查率没有显著差异（p = 0.14）。一天中的时间（p = 0.03）和病房位置（p = 0.001）是决定营养筛查的重要因素。
本研究表明了一些常见的关联因素，这些因素可能解释了住院患者营养不良筛查率较低的原因；这些因素包括看似充足的营养状况、较低的医护比和偏远的病房位置。确保对患者进行一致的营养筛查并采取适当的治疗干预措施，以及对工作人员进行教育干预，不仅可以改善患者健康，还可以在医院报销方面带来好处。
