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Implementation of a computerized system in pediatric wards to improve nutritional care: a cluster randomized trial
Background/Objectives: Malnutrition occurs frequently in hospitalized children. We aimed to assess whether a computerized system could lead to improved clinical practices in malnourished children. Subjects/Methods: Healthcare workers (242) from six departments in a pediatric university hospital part...
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| Published in: | European journal of clinical nutrition 2015-07, Vol.69 (7), p.769-775 |
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| Main Authors: | , , , , , , , , , |
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| cites | cdi_FETCH-LOGICAL-c700t-8c0182def0940a493692cad462f4a18ef5aabbe0d528239f4a61d857e6cd92c53 |
| container_end_page | 775 |
| container_issue | 7 |
| container_start_page | 769 |
| container_title | European journal of clinical nutrition |
| container_volume | 69 |
| creator | Duclos, A Touzet, S Restier, L Occelli, P Cour-Andlauer, F Denis, A Polazzi, S Colin, C Lachaux, A Peretti, N |
| description | Background/Objectives:
Malnutrition occurs frequently in hospitalized children. We aimed to assess whether a computerized system could lead to improved clinical practices in malnourished children.
Subjects/Methods:
Healthcare workers (242) from six departments in a pediatric university hospital participated in a cluster randomized trial, studying 1457 malnourished children hospitalized from September 2009 to August 2011. Following a baseline observational pre-intervention period, all departments were randomized into either intervention or control arms. A computerized malnutrition-screening system was implemented in the intervention group to automatically trigger a dietetic referral in real time. Furthermore, the nutrition support team conducted an awareness campaign with healthcare workers and a leadership-based strategy to reinforce the message during the entire study period. Adherence to practice guidelines (daily weights, investigation of etiology for malnutrition, management by a dietitian and application of refeeding protocols) was compared between pre- and post-intervention periods in both the intervention and trial arms.
Results:
When compared with the pre-intervention period, the clinical practices were significantly improved within the intervention arm for every outcome (
P |
| doi_str_mv | 10.1038/ejcn.2014.288 |
| format | article |
| fullrecord | <record><control><sourceid>gale_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_01850552v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A420325412</galeid><sourcerecordid>A420325412</sourcerecordid><originalsourceid>FETCH-LOGICAL-c700t-8c0182def0940a493692cad462f4a18ef5aabbe0d528239f4a61d857e6cd92c53</originalsourceid><addsrcrecordid>eNqFks9rFDEUxwdR7Fo9epWAIHqYNT9nMr0tRW1hwYueQzZ5s5slk6zJTKX-9WZsbassSg6Bbz7vm5eXb1W9JHhJMJPvYW_CkmLCl1TKR9WC8LapRcPx42qBO8FrhnF7Uj3LeY8L1bb0aXVCC9BR1i6qdDkcPAwQRj26GFDskUYmDodphOR-gEX5Oo8wIBfQAazTY3IGfdfJZjRG5IZDileAwlT02UB7ZHSCs9nFT6UyoaSDjcMvrwJp_7x60muf4cXtflp9_fjhy_lFvf786fJ8ta5Ni_FYS4OJpBZ63HGseceajhpteUN7romEXmi92QC2gkrKuiI2xErRQmNsIQU7rd7d-O60V4fkBp2uVdROXazWataKv8BC0CtS2Lc3bHnOtwnyqAaXDXivA8QpK9JSwgQlov0_2nSMSN4QWdDXf6H7OKUyo6woY6ShnEn8L6p4UdqVcYh7aqs9KBf6OCZt5qvVilPMqOCEFqo-Qm0hQNI-Buhdkf_gl0f4siwMzhwtePOgYAfaj7sc_TT_fT7aiUkx5wT93RcQrObkqjm5ak6uKskt_KvbKUybAewd_Tuq963mchS2kB6M6ajjTyEk9KM</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1692297005</pqid></control><display><type>article</type><title>Implementation of a computerized system in pediatric wards to improve nutritional care: a cluster randomized trial</title><source>EZB Free E-Journals</source><source>Springer Link</source><creator>Duclos, A ; Touzet, S ; Restier, L ; Occelli, P ; Cour-Andlauer, F ; Denis, A ; Polazzi, S ; Colin, C ; Lachaux, A ; Peretti, N</creator><creatorcontrib>Duclos, A ; Touzet, S ; Restier, L ; Occelli, P ; Cour-Andlauer, F ; Denis, A ; Polazzi, S ; Colin, C ; Lachaux, A ; Peretti, N ; PREDIRE Study Group ; on behalf of PREDIRE Study Group</creatorcontrib><description>Background/Objectives:
Malnutrition occurs frequently in hospitalized children. We aimed to assess whether a computerized system could lead to improved clinical practices in malnourished children.
Subjects/Methods:
Healthcare workers (242) from six departments in a pediatric university hospital participated in a cluster randomized trial, studying 1457 malnourished children hospitalized from September 2009 to August 2011. Following a baseline observational pre-intervention period, all departments were randomized into either intervention or control arms. A computerized malnutrition-screening system was implemented in the intervention group to automatically trigger a dietetic referral in real time. Furthermore, the nutrition support team conducted an awareness campaign with healthcare workers and a leadership-based strategy to reinforce the message during the entire study period. Adherence to practice guidelines (daily weights, investigation of etiology for malnutrition, management by a dietitian and application of refeeding protocols) was compared between pre- and post-intervention periods in both the intervention and trial arms.
Results:
When compared with the pre-intervention period, the clinical practices were significantly improved within the intervention arm for every outcome (
P
<0.01), whereas remained unchanged in the control arm. In addition, during the post-intervention period, malnutrition etiology investigation by physicians (adjusted odds ratio (OR) of 4.4, 95% confidence interval (CI) 1.7–11.8,
P
=0.003) and management by a dietitian (OR 2.7, 95% CI 1.0–6.9,
P
=0.046) occurred more frequently in the intervention clusters.
Conclusions:
Implementation of an electronic system to detect malnutrition in real time was associated with a rapid improvement in clinical practices for better care of hospitalized children.</description><identifier>ISSN: 0954-3007</identifier><identifier>EISSN: 1476-5640</identifier><identifier>DOI: 10.1038/ejcn.2014.288</identifier><identifier>PMID: 25649237</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/700/1720 ; Adolescent ; Care and treatment ; Child ; Child Nutrition Disorders - diagnosis ; Child Nutrition Disorders - diet therapy ; Child Nutrition Disorders - epidemiology ; Child Nutrition Disorders - etiology ; Child, Preschool ; Children ; Childrens health ; Clinical Nutrition ; Cluster Analysis ; Clusters ; Confidence intervals ; Diagnosis, Computer-Assisted ; Dietary Services - manpower ; Dietitians ; Epidemiology ; Etiology ; Feasibility Studies ; Female ; France - epidemiology ; Guideline Adherence ; Health care ; Health Plan Implementation ; Hospital information systems ; Hospital Units - manpower ; Hospital wards ; Hospitalization ; Hospitals ; Hospitals, Pediatric ; Hospitals, University ; Humans ; Infant ; Information storage and retrieval systems ; Inservice Training ; Internal Medicine ; Intervention ; Leadership ; Life Sciences ; Male ; Malnutrition ; Malnutrition in children ; Medical personnel ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Nutrition ; Nutrition Assessment ; Nutrition education ; original-article ; Pediatrics ; Pediatrics - methods ; Physicians ; Prevalence ; Public Health ; Quality management ; Real time ; Referral and Consultation</subject><ispartof>European journal of clinical nutrition, 2015-07, Vol.69 (7), p.769-775</ispartof><rights>Macmillan Publishers Limited 2015</rights><rights>COPYRIGHT 2015 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group Jul 2015</rights><rights>Macmillan Publishers Limited 2015.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c700t-8c0182def0940a493692cad462f4a18ef5aabbe0d528239f4a61d857e6cd92c53</citedby><cites>FETCH-LOGICAL-c700t-8c0182def0940a493692cad462f4a18ef5aabbe0d528239f4a61d857e6cd92c53</cites><orcidid>0000-0002-8384-8087</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25649237$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-01850552$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Duclos, A</creatorcontrib><creatorcontrib>Touzet, S</creatorcontrib><creatorcontrib>Restier, L</creatorcontrib><creatorcontrib>Occelli, P</creatorcontrib><creatorcontrib>Cour-Andlauer, F</creatorcontrib><creatorcontrib>Denis, A</creatorcontrib><creatorcontrib>Polazzi, S</creatorcontrib><creatorcontrib>Colin, C</creatorcontrib><creatorcontrib>Lachaux, A</creatorcontrib><creatorcontrib>Peretti, N</creatorcontrib><creatorcontrib>PREDIRE Study Group</creatorcontrib><creatorcontrib>on behalf of PREDIRE Study Group</creatorcontrib><title>Implementation of a computerized system in pediatric wards to improve nutritional care: a cluster randomized trial</title><title>European journal of clinical nutrition</title><addtitle>Eur J Clin Nutr</addtitle><addtitle>Eur J Clin Nutr</addtitle><description>Background/Objectives:
Malnutrition occurs frequently in hospitalized children. We aimed to assess whether a computerized system could lead to improved clinical practices in malnourished children.
Subjects/Methods:
Healthcare workers (242) from six departments in a pediatric university hospital participated in a cluster randomized trial, studying 1457 malnourished children hospitalized from September 2009 to August 2011. Following a baseline observational pre-intervention period, all departments were randomized into either intervention or control arms. A computerized malnutrition-screening system was implemented in the intervention group to automatically trigger a dietetic referral in real time. Furthermore, the nutrition support team conducted an awareness campaign with healthcare workers and a leadership-based strategy to reinforce the message during the entire study period. Adherence to practice guidelines (daily weights, investigation of etiology for malnutrition, management by a dietitian and application of refeeding protocols) was compared between pre- and post-intervention periods in both the intervention and trial arms.
Results:
When compared with the pre-intervention period, the clinical practices were significantly improved within the intervention arm for every outcome (
P
<0.01), whereas remained unchanged in the control arm. In addition, during the post-intervention period, malnutrition etiology investigation by physicians (adjusted odds ratio (OR) of 4.4, 95% confidence interval (CI) 1.7–11.8,
P
=0.003) and management by a dietitian (OR 2.7, 95% CI 1.0–6.9,
P
=0.046) occurred more frequently in the intervention clusters.
Conclusions:
Implementation of an electronic system to detect malnutrition in real time was associated with a rapid improvement in clinical practices for better care of hospitalized children.</description><subject>692/700/1720</subject><subject>Adolescent</subject><subject>Care and treatment</subject><subject>Child</subject><subject>Child Nutrition Disorders - diagnosis</subject><subject>Child Nutrition Disorders - diet therapy</subject><subject>Child Nutrition Disorders - epidemiology</subject><subject>Child Nutrition Disorders - etiology</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Childrens health</subject><subject>Clinical Nutrition</subject><subject>Cluster Analysis</subject><subject>Clusters</subject><subject>Confidence intervals</subject><subject>Diagnosis, Computer-Assisted</subject><subject>Dietary Services - manpower</subject><subject>Dietitians</subject><subject>Epidemiology</subject><subject>Etiology</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>France - epidemiology</subject><subject>Guideline Adherence</subject><subject>Health care</subject><subject>Health Plan Implementation</subject><subject>Hospital information systems</subject><subject>Hospital Units - manpower</subject><subject>Hospital wards</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Hospitals, Pediatric</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Infant</subject><subject>Information storage and retrieval systems</subject><subject>Inservice Training</subject><subject>Internal Medicine</subject><subject>Intervention</subject><subject>Leadership</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Malnutrition</subject><subject>Malnutrition in children</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Nutrition</subject><subject>Nutrition Assessment</subject><subject>Nutrition education</subject><subject>original-article</subject><subject>Pediatrics</subject><subject>Pediatrics - methods</subject><subject>Physicians</subject><subject>Prevalence</subject><subject>Public Health</subject><subject>Quality management</subject><subject>Real time</subject><subject>Referral and Consultation</subject><issn>0954-3007</issn><issn>1476-5640</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqFks9rFDEUxwdR7Fo9epWAIHqYNT9nMr0tRW1hwYueQzZ5s5slk6zJTKX-9WZsbassSg6Bbz7vm5eXb1W9JHhJMJPvYW_CkmLCl1TKR9WC8LapRcPx42qBO8FrhnF7Uj3LeY8L1bb0aXVCC9BR1i6qdDkcPAwQRj26GFDskUYmDodphOR-gEX5Oo8wIBfQAazTY3IGfdfJZjRG5IZDileAwlT02UB7ZHSCs9nFT6UyoaSDjcMvrwJp_7x60muf4cXtflp9_fjhy_lFvf786fJ8ta5Ni_FYS4OJpBZ63HGseceajhpteUN7romEXmi92QC2gkrKuiI2xErRQmNsIQU7rd7d-O60V4fkBp2uVdROXazWataKv8BC0CtS2Lc3bHnOtwnyqAaXDXivA8QpK9JSwgQlov0_2nSMSN4QWdDXf6H7OKUyo6woY6ShnEn8L6p4UdqVcYh7aqs9KBf6OCZt5qvVilPMqOCEFqo-Qm0hQNI-Buhdkf_gl0f4siwMzhwtePOgYAfaj7sc_TT_fT7aiUkx5wT93RcQrObkqjm5ak6uKskt_KvbKUybAewd_Tuq963mchS2kB6M6ajjTyEk9KM</recordid><startdate>20150701</startdate><enddate>20150701</enddate><creator>Duclos, A</creator><creator>Touzet, S</creator><creator>Restier, L</creator><creator>Occelli, P</creator><creator>Cour-Andlauer, F</creator><creator>Denis, A</creator><creator>Polazzi, S</creator><creator>Colin, C</creator><creator>Lachaux, A</creator><creator>Peretti, N</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-8384-8087</orcidid></search><sort><creationdate>20150701</creationdate><title>Implementation of a computerized system in pediatric wards to improve nutritional care: a cluster randomized trial</title><author>Duclos, A ; Touzet, S ; Restier, L ; Occelli, P ; Cour-Andlauer, F ; Denis, A ; Polazzi, S ; Colin, C ; Lachaux, A ; Peretti, N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c700t-8c0182def0940a493692cad462f4a18ef5aabbe0d528239f4a61d857e6cd92c53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>692/700/1720</topic><topic>Adolescent</topic><topic>Care and treatment</topic><topic>Child</topic><topic>Child Nutrition Disorders - diagnosis</topic><topic>Child Nutrition Disorders - diet therapy</topic><topic>Child Nutrition Disorders - epidemiology</topic><topic>Child Nutrition Disorders - etiology</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Childrens health</topic><topic>Clinical Nutrition</topic><topic>Cluster Analysis</topic><topic>Clusters</topic><topic>Confidence intervals</topic><topic>Diagnosis, Computer-Assisted</topic><topic>Dietary Services - manpower</topic><topic>Dietitians</topic><topic>Epidemiology</topic><topic>Etiology</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>France - epidemiology</topic><topic>Guideline Adherence</topic><topic>Health care</topic><topic>Health Plan Implementation</topic><topic>Hospital information systems</topic><topic>Hospital Units - manpower</topic><topic>Hospital wards</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Hospitals, Pediatric</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Infant</topic><topic>Information storage and retrieval systems</topic><topic>Inservice Training</topic><topic>Internal Medicine</topic><topic>Intervention</topic><topic>Leadership</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Malnutrition</topic><topic>Malnutrition in children</topic><topic>Medical personnel</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Nutrition</topic><topic>Nutrition Assessment</topic><topic>Nutrition education</topic><topic>original-article</topic><topic>Pediatrics</topic><topic>Pediatrics - methods</topic><topic>Physicians</topic><topic>Prevalence</topic><topic>Public Health</topic><topic>Quality management</topic><topic>Real time</topic><topic>Referral and Consultation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Duclos, A</creatorcontrib><creatorcontrib>Touzet, S</creatorcontrib><creatorcontrib>Restier, L</creatorcontrib><creatorcontrib>Occelli, P</creatorcontrib><creatorcontrib>Cour-Andlauer, F</creatorcontrib><creatorcontrib>Denis, A</creatorcontrib><creatorcontrib>Polazzi, S</creatorcontrib><creatorcontrib>Colin, C</creatorcontrib><creatorcontrib>Lachaux, A</creatorcontrib><creatorcontrib>Peretti, N</creatorcontrib><creatorcontrib>PREDIRE Study Group</creatorcontrib><creatorcontrib>on behalf of PREDIRE Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Neurosciences Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database (Proquest)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>British Nursing Database</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Agriculture Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest_Research Library</collection><collection>ProQuest Biological Science Journals</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>European journal of clinical nutrition</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Duclos, A</au><au>Touzet, S</au><au>Restier, L</au><au>Occelli, P</au><au>Cour-Andlauer, F</au><au>Denis, A</au><au>Polazzi, S</au><au>Colin, C</au><au>Lachaux, A</au><au>Peretti, N</au><aucorp>PREDIRE Study Group</aucorp><aucorp>on behalf of PREDIRE Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implementation of a computerized system in pediatric wards to improve nutritional care: a cluster randomized trial</atitle><jtitle>European journal of clinical nutrition</jtitle><stitle>Eur J Clin Nutr</stitle><addtitle>Eur J Clin Nutr</addtitle><date>2015-07-01</date><risdate>2015</risdate><volume>69</volume><issue>7</issue><spage>769</spage><epage>775</epage><pages>769-775</pages><issn>0954-3007</issn><eissn>1476-5640</eissn><abstract>Background/Objectives:
Malnutrition occurs frequently in hospitalized children. We aimed to assess whether a computerized system could lead to improved clinical practices in malnourished children.
Subjects/Methods:
Healthcare workers (242) from six departments in a pediatric university hospital participated in a cluster randomized trial, studying 1457 malnourished children hospitalized from September 2009 to August 2011. Following a baseline observational pre-intervention period, all departments were randomized into either intervention or control arms. A computerized malnutrition-screening system was implemented in the intervention group to automatically trigger a dietetic referral in real time. Furthermore, the nutrition support team conducted an awareness campaign with healthcare workers and a leadership-based strategy to reinforce the message during the entire study period. Adherence to practice guidelines (daily weights, investigation of etiology for malnutrition, management by a dietitian and application of refeeding protocols) was compared between pre- and post-intervention periods in both the intervention and trial arms.
Results:
When compared with the pre-intervention period, the clinical practices were significantly improved within the intervention arm for every outcome (
P
<0.01), whereas remained unchanged in the control arm. In addition, during the post-intervention period, malnutrition etiology investigation by physicians (adjusted odds ratio (OR) of 4.4, 95% confidence interval (CI) 1.7–11.8,
P
=0.003) and management by a dietitian (OR 2.7, 95% CI 1.0–6.9,
P
=0.046) occurred more frequently in the intervention clusters.
Conclusions:
Implementation of an electronic system to detect malnutrition in real time was associated with a rapid improvement in clinical practices for better care of hospitalized children.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>25649237</pmid><doi>10.1038/ejcn.2014.288</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-8384-8087</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0954-3007 |
| ispartof | European journal of clinical nutrition, 2015-07, Vol.69 (7), p.769-775 |
| issn | 0954-3007 1476-5640 |
| language | eng |
| recordid | cdi_hal_primary_oai_HAL_hal_01850552v1 |
| source | EZB Free E-Journals; Springer Link |
| subjects | 692/700/1720 Adolescent Care and treatment Child Child Nutrition Disorders - diagnosis Child Nutrition Disorders - diet therapy Child Nutrition Disorders - epidemiology Child Nutrition Disorders - etiology Child, Preschool Children Childrens health Clinical Nutrition Cluster Analysis Clusters Confidence intervals Diagnosis, Computer-Assisted Dietary Services - manpower Dietitians Epidemiology Etiology Feasibility Studies Female France - epidemiology Guideline Adherence Health care Health Plan Implementation Hospital information systems Hospital Units - manpower Hospital wards Hospitalization Hospitals Hospitals, Pediatric Hospitals, University Humans Infant Information storage and retrieval systems Inservice Training Internal Medicine Intervention Leadership Life Sciences Male Malnutrition Malnutrition in children Medical personnel Medicine Medicine & Public Health Metabolic Diseases Nutrition Nutrition Assessment Nutrition education original-article Pediatrics Pediatrics - methods Physicians Prevalence Public Health Quality management Real time Referral and Consultation |
| title | Implementation of a computerized system in pediatric wards to improve nutritional care: a cluster randomized trial |
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