Potential of earlier detection and treatment of disease related malnutrition with oral nutrition supplements to release acute care bed capacity.
A recent systematic review and meta-analysis shows that appropriate use of oral nutrition supplements (ONS) in community patients is associated with a significant reduction in hospitalisations. Given higher use of acute care resource by malnourished versus normally nourished patients, this paper examines the potential to reduce bed utilisation by applying these results to Irish inpatient and malnutrition prevalence data. In 2013, adults admitted to hospital with medium or high malnutrition risk scores used an estimated 36% of adult acute inpatient bed days. Targeted use of ONS in community patients might reduce hospitalisation by 168,438 adult bed days per year, equivalent to 460 beds per day. This is particularly important, given high bed occupancy rates and twelve month daily averages of 254 patients on trolleys. Relevant stakeholders should consider strategies to ensure effective ONS use with a view to improving outcomes and reducing pressure on the acute care system.
Clinical programmes have been set up to improve patient flow and optimise capacity use within Irish hospitals. Despite the need to reduce avoidable bed use and release much needed bed capacity, the potential impact of reducing disease related malnutrition (DRM) has not been examined.
Although largely preventable if detected early, DRM is a significant cause of excess morbidity and mortality in older and chronically ill patients and a major burden on healthcare systems. Due to delayed recovery and higher complication rates, poorly nourished patients have more frequent GP and outpatient visits, up to twice as many hospital admissions and longer and more complicated hospital episodes1-4. It is estimated that at any time in Ireland, DRM affects approximately 140,000 adults with associated annual care costs exceeding €1.4billion5, mostly arising in acute care settings. This is despite the fact that the vast majority of malnutrition exists in the community1 where the potential for its prevention and treatment is greatest. Read full article here
N Rice1, A Nugent2, D Byrne3, C Normand4.
2UCD Institute of Food and Health
3St James’ Hospital
4Trinity College Dublin