Early dietician involvement shortens length of stay in hospitalized patients

There appears to be a weak agreement between nurses and dieticians when screening for malnutrition among patients admitted to hospitals, and this may lead to a much longer stay, reveals a study.

A team of investigators examined the agreement between nurse and dietician nutritional risk assessments when using the Nutritional Risk Screening 2002 (NRS2002) protocol. In addition, they explored the relations of falsely labeling patients “not at risk” for malnutrition and the screening time difference (STD) between the two professions as regards the length of stay (LoS).

All patients hospitalized in a tertiary care centre between January 2017 and December 2019 who were screened for malnutrition by both a nurse and a dietician were included in this analysis. The inter-rater reliability was assessed using Cohen’s Kappa.

A linear mixed effect model was used to explore the relationship between STD and the patient classification (PCET). Finally, the investigators evaluated the association between LoS and PCET using the Kaplan‒Meier method and multivariate Cox regression, including STD with pathology group and severity of illness as random effect.

Overall, 9,085 patients had been assessed by both a nurse and a dietician. Of all the assessments made, 72 percent agreed (Kappa, 0.44).

The dietician was then involved for patients labeled “not at risk” (1.06 days; p<0.001). Compared to patients where the dietician was involved within 3 days, the LoS was 7.37 days (hazard ratio [HR], 0.51, 95 percent confidence interval [CI], 0.43‒0.61) longer for those falsely labeled “not at risk,” while for patients correctly labeled “at risk” the LoS was only 3.51 days (HR, 0.72, 95 percent CI, 0.64‒0.80).

“Avoiding falsely labeling patients ‘not at risk‘ should be a main concern upon patient admission as later involvement of dieticians is correlated with a longer LoS,” the investigators said.