None listed
Conditions
Brief summary
Many older patients admitted to hospital for acute medical illnesses are undernourished, which increases the number and length of hospital admissions. Unfortunately, treating malnutrition during a short hospital admission only produces modest improvements, so we are interested in redesigning the delivery of hospital nutrition care to continue into the post-discharge period to see if this can increase the benefits to patients. With the “Hospital to Home Outreach for Malnourished Elders” (HHOME) program, patients will receive individualised planning of nutrition needs after hospital discharge by their inpatient multidisciplinary team, supported by phone follow-up from their hospital dietitian to reinforce nutritional advice, co-ordinate community-based nutrition services and re-intervene after care would traditionally cease. The program also includes greater education of health care staff involved in the care of older patients, as well as patients and carers. By comparing patients cared for with usual hospital-only dietetics care, and those under the new HHOME program, we hope to measure an improvement in patient outcomes including nutritional and functional status. We will also measure hospital use, quality of life and costs of the new model of care, to inform whether these improvements might benefit the health system by saving future use of health services.
Interventions
Pre-implementation group receives admission risk assessment screening (including the Malnutrition Screening Tool), inpatient care by a multidisciplinary team (MDT)which may include referral to a dietitian, and discharge planning by the MDT facilitated by the nursing case manager and/or discharge facilitator to ensure basic functional and nursing needs are met in the community (usual medical care).
Intervention is a complex system change developed in consultation with key hospital and community
Pre-implementation group receives admission risk assessment screening (including the Malnutrition Screening Tool), inpatient care by a multidisciplinary team (MDT)which may include referral to a dietitian, and discharge planning by the MDT facilitated by the nursing case manager and/or discharge facilitator to ensure basic functional and nursing needs are met in the community (usual medical care). Intervention is a complex system change developed in consultation with key hospital and community stakeholders (including education, enhanced interdisciplinary communication and use of an enhanced electronic referral system). Intervention extends from the inpatient stay to 6 weeks post-discharge and includes: 1. improve identification of malnourished elders as inpatients using the Malnutrition Screening Tool (baseline audit shows gaps in completion, accuracy and generation of referrals from this routine admission screen) 2. develop and implement an individual discharge nutrition care plan for all malnourished older patients in collaboration wtih nursing case manager and/or discharge facilitator, and communicate to GP 3. provide fortnightly telephone followup by dietitian for up to 6 weeks post discharge to assess knowledge, adherence to discharge plan and trouble-shoot new problems related to nutrition 4. enhance involvement of community service providers in nutrition-related tasks (eg shopping assistance, meal preparation) in the early post-hospital period Interventions are supported by: 1. education sessions for medical unit dietitians (1-2 hours at implementation plus incorporated into position handover documentation), case managers (1 hour at tiem of implementation) and community care workers (1 hour 6 monthly) 2. written nutrition care summaries provided to patient and carer at discharge 3. nutrition discharge plan incorporated into hospital electronic referral tool 4. documentation of telephone followup occasions of service. Process audits will include documentation of nutrition discharge plan, use of the electronic referral tool, frequency and outcomes of telephone followup, and rates and types of community service referral.
Sponsors
Royal Brisbane and Women's Hospital
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Age 65 and older Discharged from general medical units at Royal Brisbane or Prince Charles hospitals Malnutrition screening tool (MST) score 2 or greater and/or body mass index <18.5 Consent to inclusion
Exclusion criteria
Discharged to residential aged care or inpatient rehabilitation facility Life expectancy <6 months Lives outside of district
Outcome results
None listed