High costs and limited dietitian services for home enteral nutrition users: A Canadian study.

BACKGROUND: Home enteral nutrition (HEN) is the provision of nutrition through a tube outside the hospital. The Canadian prevalence of HEN is not previously well understood. This study aimed to (1) describe the demographics and healthcare usage of HEN in adults in a Canadian health authority, (2) compare the proportion of HEN-related hospital visits between patients who did and did not receive a community registered dietitian (RD) follow-up, and (3) determine associations between demographic and healthcare usage of HEN adults . METHODS: A retrospective chart review was conducted on the records of HEN patients with a tube placed between April 1, 2012, and March 31, 2015. Descriptive and comparative statistics were applied. RESULTS: A total of 390 adults were discharged receiving HEN. The majority (74.9%, n = 271) of the sample did not have any record of visiting a community RD up to 6 years after tube placement. Fifty-three percent of the sample visited the hospital for HEN-related complications, costing CAD $14,324,465.00 (USD $10,677,946.00) to the healthcare system. Multiple regression analysis revealed that females ( P < .05), jejunostomy tubes ( P < .05), and older age ( P < .05) were associated with more hospital or emergency room visits. CONCLUSION: This study found a higher prevalence of HEN patients and more varied demographic and clinical characteristics than previously reported. The healthcare costs per patient per year exceed previous reports. Further research is needed to explore the population's experiences and develop interventions that improve gaps in the healthcare system.

Are Dietitians Documenting Malnutrition Based on Subjective Global Assessment Category?

Purpose: This study reports on dietitian use of the Nutrition Care Process Terminology (NCPT) diagnosis of malnutrition based on Subjective Global Assessment (SGA). Methods: Nutrition assessment reports for adults in medical, surgical, and cardiac units in 13 Canadian hospitals were retrospectively examined for a 6-week period in 2014. Reports with a SGA and NCPT diagnosis were included regardless of why the patient was seen by the dietitian. Results: Of the 932 nutrition assessment reports, 857 (92%) included an SGA. Based on SGA, the prevalence of mild to moderate malnutrition (SGA B) and severe malnutrition (SGA C) was 53.4% (n = 458) and 10.0% (n = 86), respectively. When categorized as severely malnourished, the most common NCPT diagnoses were "malnutrition" (n = 55, 72.4%), "inadequate oral intake" (n = 11, 14.5%), and "inadequate protein-energy intake" (n = 10,13.1%). Among those with SGA B and C, the assignment of the NCPT malnutrition diagnosis was 19.8% (n = 95). Conclusions: Dietitians play a key role in the prevention, identification, and treatment of malnutrition in the hospitalized patient and are well positioned to take a leadership role in improving its documentation. Ongoing audits, staff support, and training regarding NCPT use may improve the application of the malnutrition diagnosis. Future research examining dietitian barriers to using the malnutrition diagnosis would be valuable.

Gastric vs Small Bowel Feeding in Critically Ill Neurologically Injured Patients: Results of a Multicenter Observational Study.

BACKGROUND: To evaluate gastric compared with small bowel feeding on nutrition and clinical outcomes in critically ill, neurologically injured patients. MATERIALS AND METHODS: International, prospective observational studies involving 353 intensive care units (ICUs) were included. Eligible patients were critically ill, mechanically ventilated with neurological diagnoses who remained in the ICU and received enteral nutrition (EN) exclusively for at least 3 days. Sites provided data, including patient characteristics, nutrition practices, and 60-day outcomes. Patients receiving gastric or small bowel feeding were compared. Covariates including age, sex, body mass index, and Acute Physiology and Chronic Health Evaluation II score were used in the adjusted analyses. RESULTS: Of the 1691 patients who met our inclusion criteria, 1407 (94.1%) received gastric feeding and 88 (5.9%) received small bowel feeding. Adequacy of calories from EN was highest in the gastric group (60.2% and 52.3%, respectively, unadjusted analysis; P = .001), but this was not significant in the adjusted model (P = .428). The likelihood of EN interruptions due to gastrointestinal (GI) complications was higher for the gastric group (19.6% vs 4.7%, unadjusted model; P = .015). There were no significant differences in the rate of discontinuation of mechanical ventilation (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.66-1.12; P = .270) or the rate of being discharged alive from the ICU (HR, 0.94; 95% CI, 0.72-1.23; P = .641) and hospital (HR, 1.16; 95% CI, 0.87-1.55; P = .307) after adjusting for confounders. CONCLUSIONS: Despite a higher likelihood of EN interruptions due to GI complications, gastric feeding may be associated with better nutrition adequacy, but neither route is associated with better clinical outcomes.