A Duclos1, S Touzet2, L Restier3, P Occelli4, F Cour-Andlauer5, A Denis6, S Polazzi6, C Colin1, A Lachaux7, N Peretti7. 1. 1] Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France [2] Université de Lyon, EA Santé-Individu-Société 4129, Lyon, France [3] Medical School Lyon Est, Université Claude Bernard Lyon1, Lyon, France. 2. 1] Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France [2] Université de Lyon, EA Santé-Individu-Société 4129, Lyon, France. 3. Paediatric Nutrition Unit, Hospices Civils de Lyon, Bron, France. 4. 1] Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France [2] Medical School Lyon Est, Université Claude Bernard Lyon1, Lyon, France. 5. 1] Paediatric Nutrition Unit, Hospices Civils de Lyon, Bron, France [2] INSERM CIC201, Service de Pharmacologie Clinique, EPICIME, Hospices Civils de Lyon, Bron, France. 6. Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France. 7. 1] Medical School Lyon Est, Université Claude Bernard Lyon1, Lyon, France [2] Paediatric Nutrition Unit, Hospices Civils de Lyon, Bron, France [3] CarMEN Laboratory U1060, INSERM, Lyon, France.
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.
RCT Entities:
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.