Computer-aided support improves early and adequate delivery of nutrients in the ICU

In 2007 a national guideline on perioperative nutrition was issued in the Netherlands. As external indicator for adequacy of nutritional therapy, the percentage of malnourished patients who reach at least 1.2 grams of protein on day 4 after admission was chosen by the Netherlands Health Care Inspectorate.

We developed an algorithm that allows users to ask for advice on which artificial nutritional formula to prescribe and at which rate, assuring provision of adequate amounts of both protein and energy. Feedback on nutritional therapy is given to the users on a daily basis, and to the management per quarter. Both the advice and the feedback have been integrated in our data management system. The advice module is also available on-line.

In the baseline situation over the first four quarters (2006) an average of 30.2% of patients who had a full day 4 in our unit reached the protein indicator. In the last six quarters post-implementation, the average percentage reached was 56.5% with values consistently over 50%. Changes were statistically significant at third quarter of 2007 (p<0.05) and thereafter (p<0.001). Results for day 7 of admission were unaffected, which indicates that targets were reached earlier during hospital stay.

Our study shows that integration of nutritional advice and automatically generated feedback to users in a data management system consistently improves delivery of (early) nutrition.