title: Targeted Physician Education Positively Affects Delivery of Nutrition Therapy and Patient Outcomes: Results of a Prospective Clinical Trial.
abstract: BACKGROUND
  Malnutrition is a continuing epidemic among hospitalized patients. We hypothesize that targeted physician education should help reduce caloric deficits and improve patient outcomes.
  
  
  METHODS
  We performed a prospective trial of patients (n = 121) assigned to 1 of 2 trauma groups. The experimental group (EG) received targeted education consisting of strategies to increase delivery of early enteral nutrition. Strategies included early enteral access, avoidance of nil per os (NPO) and clear liquid diets (CLD), volume-based feeding, early resumption of feeds postprocedure, and charting caloric deficits. The control group (CG) did not receive targeted education but was allowed to practice in a standard ad hoc fashion. Both groups were provided with dietitian recommendations on a multidisciplinary nutrition team per standard practice.
  
  
  RESULTS
  The EG received a higher percentage of measured goal calories (30.1 ± 18.5%, 22.1 ± 23.7%, P = .024) compared with the CG. Mean caloric deficit was not significantly different between groups (-6796 ± 4164 kcal vs -8817 ± 7087 kcal, P = .305). CLD days per patient (0.1 ± 0.5 vs 0.6 ± 0.9), length of stay in the intensive care unit (3.5 ± 5.5 vs 5.2 ± 6.8 days), and duration of mechanical ventilation (1.6 ± 3.7 vs 2.8 ± 5.0 days) were all reduced in the EG compared with the CG (P < .05). EG patients had fewer nosocomial infections (10.6% vs 23.6%) and less organ failure (10.6% vs 18.2%) than did the CG, but these differences did not reach statistical significance.
  
  
  CONCLUSIONS
  Implementation of specific educational strategies succeeded in greater delivery of nutrition therapy, which favorably affected patient care and outcomes.
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota Division of Endocrinology, Mayo Clinic, Rochester, Minnesota Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Hurt
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky samcclave@louisville.edu.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McClave
authors.affiliation: Department of Surgery, The Ohio State University, Columbus, Ohio.
authors.forename: David C
authors.initials: DC
authors.lastname: Evans
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Chris
authors.initials: C
authors.lastname: Jones
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Miller
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Frazier
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mahad A
authors.initials: MA
authors.lastname: Minhas
authors.affiliation: Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Lowen
authors.affiliation: Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Allyson
authors.initials: A
authors.lastname: Stout
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jithinraj
authors.initials: J
authors.lastname: Edakkanambeth Varayil
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Matheson
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Glen A
authors.initials: GA
authors.lastname: Franklin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000592:standards*; D004493:Education; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000517:prevention & control; D008875:Middle Aged; D044623:Nutrition Therapy; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D055815:Young Adult
keywords: enteral nutrition; nutrition; nutrition support practice; nutrition support teams; outcomes research/quality