[Management in clinical nutrition].
Terms such as management, costs, efficacy, efficiency, etc. that are so common in the discourse of managers are now beginning to appear in the vocabulary of clinicians. Management in Clinical Nutrition is an innovative aspect of interest among health-care professionals dealing with the needs of undernourished patients or those at risk of malnutrition. The basic goal of this paper is to show that the tools for clinical management of hospitals are applicable to such a multidisciplinary and complex speciality as clinical nutrition and also to propose the measures needed to improve our information systems and optimize management in this field. The very concept of hospitals has changed, as has their activity, over the years. Hospitals are nowadays no longer just a charitable institution but has become a service company, a public utility for the promotion of good health and they have to be managed in accordance with criteria of efficacy, efficiency, equity and quality. The concepts of Evidence-Based Medicine (EBM) and Cost-Effective Medicine (CEM) are of evident importance in the different ways of managing health-care services. Good clinical practice is the combination of EBM and CEM. This review defines the various cost studies of fundamental importance when taking decisions in hospital management and analyzes such clinical management tools as analytical accounting, Minimum Hospital Database Set (MHDS) and encoding systems, among others, thus facilitating an analysis of the usefulness of data in clinical nutrition management systems. Finally, after reviewing some specific examples, measures are proposed to optimize current information systems. The medical staff and those of us responsible for Nutrition Units operate in hospitals as part of a centralized service transferring information to the various departments where the patient is physically located (Surgery, Internal Medicine, Digestive, ICU, etc.). One of the priority goals in micro-management and middle management is to observe the quality improvement in the discharge reports for the patients admitted, including the nutritional diagnosis within the section for the main diagnosis, and also the administration of artificial nutrition (enteral or parenteral) in the section on procedures. With all of these measures we will improve the quality of the hospitals' information systems and contribute directly to ensuring that our activities in clinical nutrition have an impact on the overall results of the hospital when measured in terms of effectiveness, efficacy or quality.
Alvarez
J
J
Sección de Endocrinología y Nutrición del Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid. juliaalvarez@jet.es
Monereo
S
S
Ortiz
P
P
Salido
C
C
D005521:Food Service, Hospital / Q000191:economics / Q000592:standards; D017721:Hospital Costs; D006801:Humans; D015596:Nutrition Assessment; D018529:Nutritional Support / Q000191:economics; D010346:Patient Care Management / Q000191:economics / Q000379:methods; D013030:Spain