Nutritional screening for improving professional practice for patient outcomes in hospital and primary care settings
Editorial Group: Cochrane Pain, Palliative and Supportive Care Group
Published Online: 6 JUN 2013
Assessed as up-to-date: 29 MAY 2013
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Omidvari AH, Vali Y, Murray SM, Wonderling D, Rashidian A. Nutritional screening for improving professional practice for patient outcomes in hospital and primary care settings. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD005539. DOI: 10.1002/14651858.CD005539.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 6 JUN 2013
Given the prevalence of under-nutrition and reports of inadequate nutritional management of patients in hospitals and the community, nutritional screening may play a role in reducing the risks of malnutrition. Screening programmes can invoke costs to health systems and patients. It is therefore important to assess the effectiveness of nutritional screening programmes.
To examine the effectiveness of nutritional screening in improving quality of care (professional practice) and patient outcomes compared with usual care.
We searched the following databases: CENTRAL (The Cochrane Library), MEDLINE, EMBASE and CINAHL up to June 2012 to find relevant studies.
Randomised controlled studies, controlled clinical trials, controlled before-after studies and interrupted time series studies assessing the effectiveness of nutritional screening were eligible for inclusion in the review. We considered process outcomes (for example patient identification, referral to dietitian) and patient outcomes (for example mortality, change in body mass index (BMI)). Participants were adult patients aged 16 years or over. We included studies conducted in different settings, including hospitals, out-patient clinics, primary care or long term care settings.
Data collection and analysis
We independently assessed the risk of bias and extracted data from the included studies. Meta-analysis was considered but was not conducted due to the discrepancies between the studies. The studies were heterogeneous in their design, setting, intervention and outcomes. We analysed the data using a narrative synthesis approach.
After conducting initial searches and screening the titles and abstracts of the identified literature, 77 full text papers were retrieved and read. Ultimately three studies were included. Two controlled before-after studies were conducted in hospital settings (one in the UK and one in the Netherlands) and one cluster randomised controlled trial was conducted in a primary care setting (in the USA).
The study conducted in primary care reported that physicians were receptive to the screening intervention, but the intervention did not result in any improvements in the malnutrition detection rate or nutritional intervention rate. The two studies conducted in hospitals had important methodological limitations. One study reported that as a result of the intervention, the recording of patients' weight increased in the intervention wards. No significant changes were observed in the referral rates to dietitians or care at meal time. The third study reported weight gains and a reduction in hospital acquired infection rate in the intervention hospital. They found no significant differences in length of stay, pressure sores, malnutrition and treatment costs per patient between the two hospitals.
Current evidence is insufficient to support the effectiveness of nutritional screening, although equally there is no evidence of no effect. Therefore, more high quality studies should be conducted to assess the effectiveness of nutritional screening in different settings.
Plain language summary
Nutritional screening for improving patient care and professional practice
There are often inadequate processes in place to identify patients who are malnourished or at risk of malnutrition in hospitals and in the community. Therefore nutritional screening as a tool for identifying these patients may have an important role in reducing the risks of malnutrition. There are several reports on implementing nutritional screening programmes, but there are associated costs to health systems and patients. It is therefore important to assess the effectiveness of nutritional screening programmes. We searched for studies evaluating the effects of nutritional screening as a main intervention in hospital and primary care settings on patient outcomes such as mortality, illness, health related quality of life, and change in BMI or weight. We also searched for studies evaluating process outcomes like identification of patients requiring nutritional care, data recording (e.g. weight and BMI), or referral of patients to dietitians or similar. Three studies met our inclusion criteria, but they were very dissimilar in their design, setting, intervention and outcomes. One study found that primary care physicians were receptive to the intervention but it did not result in any improvement in detection rate and nutritional intervention rate. Two studies were conducted in hospitals: one reported that patients’ weight documentation increased as a result of the intervention, and the other reported significant weight gains and reduction in hospital acquired infection rate in the intervention hospital. Both of these studies suffered from limitations in their design, and it was not possible to rule out the impact of confounding factors on their findings. As a result, we conclude that evidence on the effectiveness of nutritional screening is insufficient. Therefore, further high quality studies should be conducted to assess the effectiveness of nutritional screening programmes in hospitals and communities.