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Tutorial: Development and Implementation of a Multidisciplinary Preoperative Nutrition Optimization Clinic.

David G A Williams^1,2, Elizabeth Villalta³, Solomon Aronson^1,4

¹Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA.

JPEN. Journal of Parenteral and Enteral Nutrition

|April 2, 2020

Summary

Addressing preoperative malnutrition in surgical patients is crucial. A new clinic program led by registered dietitians aims to optimize nutrition, improving outcomes and reducing costs for surgical care.

Keywords:

health outcomes malnutrition nutrition risk preoperative care registered dietitian surgery

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Area of Science:

Surgical outcomes research
Clinical nutrition
Healthcare systems innovation

Background:

Preoperative malnutrition is a prevalent, modifiable risk factor in surgery.
Undertreated malnutrition significantly increases postoperative mortality, morbidity, length of stay, readmissions, and costs.
Perioperative malnutrition is often unrecognized and undertreated, termed a 'silent epidemic'.

Purpose of the Study:

To describe the development and implementation of a multidisciplinary, registered dietitian-driven preoperative nutrition optimization clinic.
To improve perioperative outcomes and reduce healthcare costs associated with surgical nutrition risk.

Main Methods:

Established the Perioperative Enhancement Team (POET) Nutrition Clinic, requiring interdisciplinary collaboration.
Developed multidimensional scheduling, data tracking systems, dashboards, and electronic health record integration.
Created and validated a structured malnutrition risk score (Perioperative Nutrition Screen) and pathway.

Main Results:

Successfully implemented a novel, dietitian-driven clinic model for preoperative nutrition optimization.
Established a structured malnutrition risk score and pathway for systematic assessment and intervention.
Defined a key role for perioperative registered dietitians in delivering integrated nutrition care.

Conclusions:

The POET Nutrition Clinic model offers a structured approach to perioperative nutrition assessment and optimization.
This model has the potential for wide implementation and generalizability to improve recognition and treatment of surgical nutrition risk globally.
Optimizing preoperative nutrition is essential for enhancing surgical patient outcomes and reducing healthcare expenditures.