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Clinical Nutrition

Implementation of a computerized system in pediatric wards to improve nutritional care: a cluster randomized trial

European Journal of Clinical Nutrition volume 69, pages 769–775 (2015)Cite this article

Subjects

Abstract

Background/Objectives:

Malnutrition occurs frequently in hospitalized children. We aimed to assess whether a computerized system could lead to improved clinical practices in malnourished children.

Subjects/Methods:

Healthcare workers (242) from six departments in a pediatric university hospital participated in a cluster randomized trial, studying 1457 malnourished children hospitalized from September 2009 to August 2011. Following a baseline observational pre-intervention period, all departments were randomized into either intervention or control arms. A computerized malnutrition-screening system was implemented in the intervention group to automatically trigger a dietetic referral in real time. Furthermore, the nutrition support team conducted an awareness campaign with healthcare workers and a leadership-based strategy to reinforce the message during the entire study period. Adherence to practice guidelines (daily weights, investigation of etiology for malnutrition, management by a dietitian and application of refeeding protocols) was compared between pre- and post-intervention periods in both the intervention and trial arms.

Results:

When compared with the pre-intervention period, the clinical practices were significantly improved within the intervention arm for every outcome (P<0.01), whereas remained unchanged in the control arm. In addition, during the post-intervention period, malnutrition etiology investigation by physicians (adjusted odds ratio (OR) of 4.4, 95% confidence interval (CI) 1.7–11.8, P=0.003) and management by a dietitian (OR 2.7, 95% CI 1.0–6.9, P=0.046) occurred more frequently in the intervention clusters.

Conclusions:

Implementation of an electronic system to detect malnutrition in real time was associated with a rapid improvement in clinical practices for better care of hospitalized children.

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Acknowledgements

The following are members of the PREDIRE Study Group: Audrey Alleon, Gabriel Bellon, Jérôme Berard, Daniel Betito, Laëtitia Bouveret, Marion Caradec, Philippe Castets, Pierre Cochat, Cyrille Colin, Fleur Cour-Andlauer, Raissa Dahalani, Emilie Delage, Angélique Denis, Vincent Desportes, Antoine Duclos, Carole Ford-Chessel, Pierre Fourneret, Guillaume Gamba, Alain Lachaux, Marie-Claude Laval, Manolita Lopez, Pierre Mouriquand, Marc Nicolino, Pauline Occelli, Emilie Oumedian, Brigitte Pasty, Noël Peretti, Laurence Perrot, Stéphanie Polazzi, Patricia Poulet, Lioara Restier, Anne Roux, Pauline Vidal, Sandrine Touzet, Virginie Treynet, Pauline Vidal, Amélie Zelmar (Hospices Civils de Lyon), Cécile Chambrier, Virginie Colomb, Pauline Coti, and José Labarère (Scientific Committee). ADu and NP obtained funding and supervised the study. ADu, CC, LR, NP and ST conceived and designed the study. ADe, ADu, AL, CC, FC, LR, NP, PO, SP and ST were responsible for data acquisition and provided administrative, technical or material support. ADe, ADu, NP, PO and ST analyzed and interpreted the data. ADu, NP and ST drafted the manuscript. ADe, ADu, AL, CC, FC, LR, NP, PO, SP and ST critically revised the manuscript. All authors approved the final version of the manuscript for publication. ADu and NP act as guarantors. All authors had full access to the data and take responsibility for its integrity and the accuracy of analysis. The study was approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Because the intervention and randomization were targeted at the cluster level and outcome data were routinely collected, national review boards waived the requirement for individual consent. However, responsible authorities from all the departments provided written consent without incentives for their participation. Printed information about personal data utilization was given to the children's parents at admission, and their potential refusal to share hospitalization data was considered. Details that might disclose the identity of the subjects under study were omitted. All phases of this study were supported by a grant from the Research Program for Quality in Hospital (Programme de Recherche en Qualité Hospitalière) 2008 of the French Ministry of Health (Ministère chargé de la Santé, Direction de l′Hospitalisation et de l′Organisation des Soins), Hospices Civils de Lyon. Clinical Trials NCT01081587 (available at http://www.clinicaltrials.gov/ct2/home).

Author information

Author notes

  1. Members of the PREDIRE Study Group are listed in the Acknowledgements section.

Authors and Affiliations

  1. Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France

    A Duclos, S Touzet, P Occelli, A Denis, S Polazzi & C Colin

  2. Université de Lyon, EA Santé-Individu-Société 4129, Lyon, France

    A Duclos, S Touzet & C Colin

  3. Medical School Lyon Est, Université Claude Bernard Lyon1, Lyon, France,

    A Duclos, P Occelli, C Colin, A Lachaux & N Peretti

  4. Paediatric Nutrition Unit, Hospices Civils de Lyon, Bron, France,

    L Restier, F Cour-Andlauer, A Lachaux & N Peretti

  5. INSERM CIC201, Service de Pharmacologie Clinique, EPICIME, Hospices Civils de Lyon, Bron, France

    F Cour-Andlauer

  6. CarMEN Laboratory U1060, INSERM, Lyon, France

    A Lachaux & N Peretti

Authors
  1. A Duclos
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  2. S Touzet
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  3. L Restier
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  4. P Occelli
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  5. F Cour-Andlauer
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  6. A Denis
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  7. S Polazzi
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  8. C Colin
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  9. A Lachaux
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Consortia

on behalf of PREDIRE Study Group

Corresponding author

Correspondence to A Duclos.

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Competing interests

The authors declare no conflict of interest.

Additional information

Conference presentation: The study’s main results were presented as oral communication at the 29th International Society for Quality in Health Care Conference (Geneva, Switzerland, 21–24 October 2012) and the 46th Annual Meeting of The European Society of Paediatric Gastroenterology, Hepatology and Nutrition (London, UK, 8–11 May 2013).

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Duclos, A., Touzet, S., Restier, L. et al. Implementation of a computerized system in pediatric wards to improve nutritional care: a cluster randomized trial. Eur J Clin Nutr 69, 769–775 (2015). https://doi.org/10.1038/ejcn.2014.288

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  • DOI: https://doi.org/10.1038/ejcn.2014.288

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