By Dr. Sam Beattie, Nutrition Services
For several years, we have been writing about how malnutrition impacts hospitalization and is a leading co-factor in readmissions. A white paper outlining the evidence for the importance of nutrition in transition from the hospital is available here.
Now there is more evidence that malnutrition creates negative outcomes post discharge. A clinical study conducted by researchers at Brigham and Women’s Hospital evaluated the nutritional status of patients admitted to Intensive Care Units (ICU) and determined outcomes for those patients.
The study compared ICU outcomes for patients who were not malnourished upon admission, to those with either protein energy malnutrition (PEM) or nonspecific malnutrition. This was a relatively large study with over 3000 patients who survived hospitalization and were discharged into their homes.
Findings showed ICU patients who were malnourished upon admittance to ICU were:
- More likely to be readmitted within 30 days of discharge
- More likely to die within 90 days of discharge
In looking at the data, it is clear that PEM upon admission to ICU is a contributor to readmissions and mortality in discharged patients. Importantly, the study also found that use of various drugs increased with malnourished patients.
The researchers underscored the importance of post-hospitalization nutrition. The fact that we discharge patients without knowing if they have food at home is a concern and has been shown to be a contributing factor to readmissions and emergency department visits.
Currently, estimates are that readmissions in the Medicare populations are costing $15 billion every year. Simply feeding people prior to admission and post discharge could go a long way to improving outcomes and reducing overall healthcare costs in the United States.
Mogensen K, et al. “The association of malnutrition and 30-day post discharge hospital readmission in ICU survivors: A registry based cohort study” SCCM 2013; Abstract 54.