Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.
Nutrition and Dietetics Department, Logan Hospital, Meadowbrook, Queensland, Australia.
J Hum Nutr Diet. 2019 Apr;32(2):267-275. doi: 10.1111/jhn.12619. Epub 2019 Jan 22.
Dietetic models of care at Logan Hospital changed from all patients with a confirmed stroke receiving dietitian assessment (Old pathway) to only those patients screened as high-nutritional-risk (Modified pathway). However, it was unknown whether all low-nutritional-risk patients who were indicated for dietitian assessment for nutrition support actually received assessment. This pre-post retrospective study evaluated whether the Old pathway and the Modified pathway were equally effective in identifying low-nutritional-risk stroke patients who were indicated for dietitian assessment and compared the time spent providing Dietetic care.
For both pathways, medical charts were reviewed for low-nutritional-risk patients admitted between December 2012 and November 2017 with a confirmed stroke, who were given a standard food and fluid diet code and scored MST < 2 (Malnutrition Screening Tool) on admission. Data collected included demographics, anthropometrics, malnutrition assessment, dietetic intervention and time spent caring for patients. Malnutrition-related clinical indicators were used to classify patients as either Dietitian Assessment for Nutrition Support Indicated or Not Indicated.
Low-nutritional-risk patients were similar on the Old (n = 180) and Modified (n = 206) pathways [mean (SD) 66 (13) years, 63% male, 4% malnutrition]. Those classified as Dietitian Assessment for Nutrition Support Indicated (n = 61 of 180) were older, had a longer length of stay (P < 0.05), and were all identified by the Dietitian on both pathways. Ten minutes less dietetic time per patient was required on the Modified pathway (P < 0.001).
The Modified Nutrition Stroke pathway performed more efficiently than the Old pathway and was equally effective at ensuring that stroke patients who were determined as being low-nutritional-risk received dietitian assessment during admission if indicated.
洛根医院的饮食护理模式发生了变化，所有确诊为中风的患者都接受营养师评估（旧路径），改为仅对高营养风险患者进行筛查（改良路径）。然而，尚不清楚所有需要营养师评估营养支持的低营养风险患者是否都接受了评估。本回顾性研究比较了旧路径和改良路径在识别需要营养师评估的低营养风险中风患者方面的效果，并比较了提供饮食护理的时间。
对于两条路径，均对 2012 年 12 月至 2017 年 11 月期间入院并确诊为中风、给予标准饮食和液体饮食代码且入院时 MST<2（营养不良筛查工具）的低营养风险患者的病历进行了回顾。收集的数据包括人口统计学、人体测量学、营养不良评估、饮食干预和照顾患者的时间。使用与营养不良相关的临床指标对患者进行分类，分为需要营养师评估营养支持和不需要营养师评估营养支持。
旧路径（n=180）和改良路径（n=206）的低营养风险患者相似[平均（标准差）66（13）岁，63%为男性，4%为营养不良]。被分类为需要营养师评估营养支持的患者（n=180 中的 61 例）年龄较大，住院时间较长（P<0.05），并且在两条路径上均由营养师识别。改良路径下每位患者所需的饮食护理时间减少了 10 分钟（P<0.001）。
改良的营养性中风路径比旧路径更有效率，并且在确保低营养风险的中风患者在入院时如果需要接受营养师评估方面同样有效。
