Malnutrition
Conditions
Keywords
disease related malnutrition, influence of Nutrition Support Team, length of hospital stay, quality of life, body composition, health care costs
Brief summary
The purpose of this study is to investigate the effectiveness and efficiency of a structural clinical nutrition support by an interdisciplinary Nutrition Support Team. To do this we examine nutritional management and its economic impact as well as the nutritional status of patients of University Hospital Tübingen before and after the implementation of a Nutritional Support Team.
Detailed description
In German hospitals disease related malnutrition is a major problem. Malnutrition is known to be associated with decreased quality of life, altered body composition as well as increased length of hospital stay. Guidelines recommend the installation of Nutrition Support Teams (NST) to combat this situation. However, the majority of German hospitals lacks a NST. In the present study, we want to examine the effectiveness and efficiency of a Nutrition Support Team (NST) in an University hospital with 1500 beds. To do this we investigate the nutritional management, its economic impact and patient related data before and after NST-implementation. Examinations include a structural analysis of the hospital with regard to nutritional procedures and a patient-based analysis. Patients are recruited from three representative normal wards and two intensive care units. Here we identify patients with risk for malnutrition with the help of nutritional screening tools (NRS 2002 \[Nutritional Risk Screening\]; NUTRIC \[Nutritional Risk in the critically ill\] Score).This is performed within the first three days after admittance. The patients with risk for malnutrition (NRS 2002 of 3 or more than 3, NUTRIC Score of 4 or more than 4) are included for further investigations. These include anthropometric measurements , assessment of body composition, evaluation of nosocomial infection and decubitus rate, quality of life (SF-12 questionnaire), length of hospital stay, evaluation of mortality risk, organ function and severity of illness as well as economic factors. Most examinations are repeated weekly depending from the length of stay in hospital. All this examinations and evaluations will be collected at two time points. Before and after the implementation of a nutritional support team. That means we have two groups: group A- before NST-implementation (n=420) and group B - after NST-implementation (n=420). After the whole data collection we want to compare the results of the two groups.
Interventions
None listed
Sponsors
Center for Nutritional Medicine Tuebingen/Hohenheim
University Hospital Tuebingen
University of Hohenheim
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patient of University Hospital Tübingen * patient of one of the study-wards: Gastroenterology, Otolaryngology, Visceral and transplantation surgery, Internal intensive care unit, Surgery intensive care unit * written informed consent of the patient/advisor * risk of malnutrition: NRS Score of 3 or more than 3, NUTRIC Score of 4 or more than 4
Exclusion criteria
* age under 18 years * withdrawn of written informed consent * length of hospital stay shorter than 2 days
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| length of hospital stay | Patients will be followed for the duration of hospital stay. Average hospital stay is about 7 days. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| case-related total costs of length of hospital stay | At time of hospital discharge.Average hospital stay is about 7 days. | — |
| Score (points) of Nutritional risk Screening | Within the first 3 days after admittance | Patients at normal wards are screened with NRS 2002 (Nutritional Risk Screening 2002). Patients at intensive care units are screened with NUTRIC (Nutritional Risk in the critically ill) Score. |
Other
| Measure | Time frame | Description |
|---|---|---|
| BMI | Within the first 3 days after admittance | To asses the BMI we measure the height and weight of the patients and calculate the BMI. |
| mortality risk | Within the first 3 days after admittance | We evaluate the mortality risk by using SAP II (Simplified Acute Physiology) Score. The SAP II Score is only used on patients at intensive care units. |
| severity of illness and organ function | Every day -from first day of hospital stay to discharge.Average hospital stay is about 7 days. | We evaluate the severity of illness and organ function by using SOFA (Sequential Organ Failure Assessment) Score. The SOFA Score is only used on patients at intensive care units. |
| mortality | From day 1 to discharge.Average hospital stay is about 7 days. | — |
| nosocomial infection | At time of hospital discharge.Average hospital stay is about 7 days. | — |
| quality of life | within 3 days after admittance | Quality of life is assessed by using the standardized questionnaire short-form 12 ( SF-12). |
| decubitus risk | within the first 3 days after admittance | We evaluate decubitus-risk by using Braden-Scale. |
| body composition | Within the first 3 days after admittance | To measure the body composition we use the bioelectrical impedance analysis. We evaluate the phase angle and ECM (extracellular cell mass)/BCM (body cell mass) ratio. |
| case-individual costs of hospital stay | At time of hospital discharge.Average hospital stay is about 7 days. | — |
Countries
Germany
Contacts
Primary ContactStephan C. Bischoff, Professor
Backup ContactKatrin Mannsdoerfer
Outcome results
None listed