Implementation of a computerized system in pediatric wards to improve nutritional care: a cluster randomized trial

• Published in: European journal of clinical nutrition Vol. 69; no. 7; pp. 769 - 775
• Main Authors: Duclos, A, Touzet, S, Restier, L, Occelli, P, Cour-Andlauer, F, Denis, A, Polazzi, S, Colin, C, Lachaux, A, Peretti, N
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.07.2015; Nature Publishing Group
• 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; France; Hospital Units/manpower; Pediatrics/methods; Prevalence; France/epidemiology; Humans; Male; Infant; Nutrition Assessment; Feasibility Studies; Female; Diagnosis; Child; Inservice Training; Health Plan Implementation; Preschool; Computer-Assisted; Hospitals; Guideline Adherence; University; Child Nutrition Disorders/diagnosis/diet therapy/epidemiology/etiology; Dietary Services/manpower; Adolescent; Referral and Consultation; Pediatric; Cluster Analysis
• ISSN: 0954-3007; 1476-5640; 1476-5640
• DOI: 10.1038/ejcn.2014.288

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.