Malnutrition is a bigger problem than we imagined, according to Gastroenterology & Endoscopy News. One in three Americans is admitted to hospitals with malnourishment, which heightens the probabilities of unfavorable effects. The Centers for Medicare & Medicaid Services (CMS) withholds payment from hospitals for preventable ailments due to malnourishment, such as surgical site infections, pressure ulcers and postoperative pneumonia, so why isn't more being done about patients' nutrition?
"Malnutrition can increase the risk of hospital-acquired infections, increasing the patient's length of stay and increasing their risk of morbidity and mortality," explained Carmen Roberts, a clinical dietitian specialist at Johns Hopkins Bayview Medical Center, according to Gastroenterology & Endoscopy News. "It can also interfere with the health care practitioner's ability to adequately and successfully treat the patient while he or she is in the hospital."
"Of course, there is never one thing that influences a patient's stay in the hospital, but malnutrition can be a significant factor," said Dr. Melissa Parkhurst, associate professor in the Department of Internal Medicine at the University of Kansas Medical Center, according to Gastroenterology & Endoscopy News.
"The data we have over a number of years consistently show that one in three patients enters the hospital already meeting the criteria for malnourishment," Parkhurst told Gastroenterology & Endoscopy News. "We know that if left unattended, about two-thirds will experience further decline while they are in the hospital."
Even well-nourished people are at risk of decline when they are admitted to the hospital due to poor nutrition topped with illness, dietary restrictions and gastrointestinal problems, according to Gastroenterology & Endoscopy News.
"There are multiple reasons why malnutrition in the hospital is an issue," Parkhurst told Gastroenterology & Endoscopy News. "The hospital care of a patient is a complex system with a lot of moving parts and a lot of things that are competing for the attention of the physician, nurses and administrators. Then on top of that, you add a lack of general understanding of the cost of malnutrition and lack of awareness and inaction."
Many patients are placed on NPO orders (Nil Per Os, or "nothing by mouth"), miss meals due to x-rays or other out-of-room testing, stop eating because they do not like the meals or have pain that causes a lack of hunger. The profound effects of inadequate calories often go unnoticed over the course of a hospital stay.
Malnutrition in health care facilities is not a novel issue. Dr. Charles E. Butterworth Jr. called malnutrition the "skeleton in the hospital closet" in a 1984 study, because it often slides in under the radar and goes essentially untreated, according to Gastroenterology & Endoscopy News.
The Joint Commission implemented a rule that states a person must be assessed for nutritional needs when they enter the hospital, according to Gastroenterology & Endoscopy News, but the commission did not provide guidelines on management and care, according to Parkhurst. The average length of stay for a hospital patient is often five days, so patients are often discharged before the assessment can be completed.
"Dietitians need to do an assessment within a timely fashion of the screening coming back at risk," Parkhurst said, according to Gastroenterology & Endoscopy News. "And the dietitian's recommendations, which are only implemented about 40 percent of the time, need to be followed up by the physician-led team."
