Recovery from the inside out: Program targets malnutrition in hospitalized patients
UT Southwestern recently launched an inpatient Nutrition Support Team to provide specialized nutritional consultation services for high-risk patients at William P. Clements Jr. University Hospital.
Dr. Sara Hennessy, Director of the Surgical Intensive Care Unit, and Dr. Jeffrey Browning, Chair of Clinical Nutrition, lead the program. Their vision is to use a multidisciplinary team to identify, diagnose, and treat malnutrition.
According to Dr. Hennessy, malnutrition is widespread and often unrecognized. The first phase of the program will target patients who could be at highest risk, requiring total IV nutrition, or parenteral nutrition, administered directly into the bloodstream intravenously.
This may be necessary in older people with multiple comorbidities or otherwise healthy people who have gone through a complex operation or medical condition.
“Approximately 25 to 50 percent of all hospitalized patients have some degree of malnutrition, however only 4 percent are recognized by physicians. Malnutrition comes in all shapes and sizes, in the underweight or obese patient, in both the elderly and the young,” explained Dr. Hennessy, Assistant Professor of Surgery. “Malnutrition leads to significantly higher rates of morbidity and mortality in hospitalized patients and is associated with longer hospital stays, higher readmission rates, and higher hospital costs.”
Since launching in June 2020, the Nutrition Support Team has treated more than 100 inpatients requiring IV nutrition.
“The benefit of this addition to our current program is that we are using a multidisciplinary approach for the nutritional care of a patient to identify risks, decide appropriate treatment, and provide care in an efficient and effective manner,” Dr. Hennessy explained.
Early intervention can prevent or treat malnutrition, which is not only a consequence of many diseases but can also be caused by chronic illness, major surgery, difficulty eating, or limited absorption of food.
Patient assessments are conducted to gather a person’s nutrition history. This includes past and recent appetite, types of foods and beverages consumed, weight and body composition changes, vitamin or supplement regimens, and whether anything is affecting the patient’s ability to eat (such as changes in taste or difficulty swallowing).
Registered dietitians provide nutrition education, which covers weight management and how to read nutrition labels, among other topics.
According to Amanda Lidster, Registered Dietitian for the program, patients are primarily referred to the program from oncology, surgery, and bariatric departments. She sees about 12-15 patients daily, ranging in age from 20 to 70.
“Most of these patients are unable to use their gastrointestinal tract,” said Ms. Lidster. “Receiving nutrition through their bloodstream allows the bowel to heal after surgery or after an injury.”
Even after returning home, some patients continue to receive nutrition intravenously. The process is similar to receiving hydration. The fluid can be personalized for each patient, and typically contains a combination of protein, carbohydrates, vitamins, minerals, lipids, electrolytes, zinc, and selenium. Accommodations can be made for special dietary needs such as allergies.
The team’s long-term goal is to ensure appropriate and accurate nutrition for hospitalized patients, which in turn will help reduce costs and decrease length of stay, readmissions, and health complications such as infections. Their success will be measured by establishing criteria for appropriate parenteral nutrition use, improving the quality and safety around parenteral nutrition, and measuring long-term improvement in hospital length of stay and readmission.
The nutritional service line concept was Dr. Hennessy’s Capstone Leadership Project for the LEAD (Leadership Emerging in Academic Departments) program, for which she won the UT Southwestern Medical Center LEAD Capstone Project Award in 2019. With the support of Dr. Herbert Zeh, Professor and Chair of Surgery; Dr. Ezra Burstein, Division Chief and Professor of Internal Medicine and Molecular Biology; and Dr. Browning, the concept of a Nutrition Support Team gained approval and funding to launch in summer 2020.
Other members of the faculty team include Drs. Sneha Bhat and Hillary Prince, Assistant Professors of Surgery.
In the future, Dr. Hennessy would like to expand the Nutrition Support Team by creating specialized nutritional pathways for different patient groups, such as those with Inflammatory Bowel Disease (IBD), building a unified outpatient program for all departments, and creating a link from inpatient to outpatient dietitians.
“Nutrition is tied into all aspects of patient care. With our multidisciplinary approach, I’m confident that we can make a significant difference in patient care and outcomes,” Dr. Hennessy said.