The effects of a dietitian-supported multidisciplinary nutrition intervention on optimizing nutrition care in older patients with hip fracture and at nutrition risk-A quality improvement study.

Abstract

Introduction: A 1-day cross-sectional study at our hospital found that only 22% of patients with hip fractures at nutrition risk met their energy and protein requirements during hospitalization. This study aimed to test whether closer collaboration between a clinical dietitian and ward staff, guided by the Model for Improvement, could optimize nutrition care for hospitalized older patients with hip fractures at nutrition risk.

Method: A dietitian was embedded to facilitate staff-led enhancements in nutrition care at an orthopedic ward in from September to December 2024. Two Plan-Do-Study-Act cycles were implemented. Cycle 1 focused on nutrition documentation. Cycle 2 targeted nutrition intake. The primary outcome was the proportion of patients meeting individual energy and protein requirements (≥80%). Secondary process indicators were (1) ≥80% of patients screened using Nutrition Risk Screening 2002, and (2) ≥80% of at-risk patients with intake documented in the medical record. Preintervention data served as the baseline.

Results: The primary outcome was achieved, with 80% (8 of 10) of patients meeting both energy and protein requirements, a significant improvement from 22% (2 of 9) at baseline (P < 0.05). Documentation of nutrition risk increased from 10% (1 of 10) to 80% (8 of 10) (P < 0.01), and intake documentation improved from 30% (3 of 10) to 100% (10 of 10) (P < 0.01).

Conclusion: This quality improvement study demonstrates that applying the Model for Improvement to integrate a clinical dietitian into ward practice strengthened interdisciplinary nutrition care and led to measurable gains in screening, documentation, and nutrition intake among older patients with hip fractures at nutrition risk.