Why nutrition matters: How Advocate Health Care cut readmissions, LOS & costs

Upon admission to a hospital, 30 percent to 50 percent of patients are already malnourished. During a hospital stay, many normally nourished patients experience a decline.

"Malnutrition can happen to anyone," said Gretchen VanDerBosch, senior dietitian at Barrington, Ill.-based Advocate Good Shepherd Hospital. "If you lose 5 percent of your bodyweight during your stay, you have an increased risk of being readmitted to the hospital."

Ms. VanDerBosch and Maureen Dziadosz, director of clinical informatics south region at Downers Grove, Ill.-based Advocate Health Care, emphasized why nutrition matters for healthcare organizations during Becker's Hospital Review Health IT + Clinical Leadership conference, May 10, in Chicago.

Many don't realize malnutrition weighs heavily on a hospital's cost and care, resulting in:

  • Length of stay increased by 2.3 days 
  • Increased readmission rates
  • Increased cost of care
  • Five times higher complication rates
  • Increased morbidity/mortality
  • Four times increased risk of pressure ulcers

"Costs really add up when you're trying to take care of malnourished patients," Ms. VanDerBosch said. Enter oral nutritional supplements to combat this costly challenge. Published in 2013, Philipson TJ et al. found ONS administration during hospitalization decreased 30-day readmissions by 6.7 percent, LOS by 21 percent and episode costs by 21.6 percent.

ONS for malnourished patients offers the following benefits:

"[ONS is] a low-cost, effective remedy to help our patients," said Ms. VanDerBosch.

Advocate conducted its own study of 1,269 patients, testing the impact of a nutrition-focused quality improvement program on readmission rates for at risk/malnourished patients in four of its hospitals.

To build an effective study, Ms. VanDerBosch and her team recognized the need for a health IT element. That's where Ms. Dziadosz came in. She headed creation of an evidence-based malnutrition screening tool within the patient history form on the EMR. An example of a question on this screening was, 'Have you recently lost weight without trying?'

"We actually leveraged the electronic medical record to do a bunch of tasks for us by creating rules," Ms. Dziadosz said. "Those pieces were so easy to put in the electronic medical record, anyone could do it." For example, if a patient received a malnutrition screening tool score of two or greater, the EMR triggered a dietician consult. If a diet order was placed, an EMR rule automatically input an oral nutrition order without anyone having to place it.

"The next meal that patient is getting their nutrition supplement, versus taking up anywhere to 96 hours," Ms. Dziadosz said. "Once we switched over to the rule, [patients] were getting their supplements within 12 hours of being admitted."

As a result of the study:

  • All-cause 30-day readmissions decreased by 29 percent
  • LOS dropped 26 percent
  • Six-month cost savings totaled nearly $4.9 million

Ms. VanDerBosch emphasized every patient load — whether younger or older; surgical or medical; oncology or cardiovascular — experienced outcome benefits from taking ONS.

"There is clear evidence from our study that nutritional supplements can improve readmissions, can decrease length of stay and can improve your financials," said Ms. Dziadosz.


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