IMPLEMENTING A COMPUTERISED SYSTEM WITH STANDARDISED LANGUAGE TO ENHANCE EFFICIENCY OF NUTRITION CARE IN A HEMODIALYSIS POPULATION

Abstract

To assess the impact of the implementation of an information technology system using standardized language (International Dietetic and Nutrition Terminology, IDNT) on efficiency and patient outcomes. This was a longitudinal study of hemodialysis patients (≥18 years, ≥3 months dialysis vintage) at a single facility. During the first 6 month period (months 0–6), patients received usual standard of care, with documentation via a manual paper-based system. During the following 6–month period (months 7–12), nutritional care was documented and tracked by a computerized system incorporating IDNT. Improvement or deterioration in nutritional status was determined via routine nutritional assessment and documented using IDNT. Workload efficiency was determined using a Workload Mapping Tool. Difference between systems was assessed using t-test for continuous and chi-square test for categorical variables. Ninety-one patients were recruited at baseline, another 12 patients in the final 6 month intervention period (age (SD) 58 years (16), 53% male (n=55), vintage 43 months (inter-quartile range, 25 to 75 months), malnutrition by SGA, 10.9%). Introduction of the computerized system resulted in a higher rate of resolution of nutritional diagnoses (mean 1.43 (CI 1.19–1.67) compared with the paper-based system (mean 0.68 (CI 0.49–0.87)) (p1.6 mmol/L) decreased from 73% to 59% with introduction of the new system, and dry weight change improved (mean difference 1.6% (SD 5.2) (p=0.025)). There was no significant difference in malnutrition rates (p=0.586) or inter-dialytic fluid gains (p=0.836). Efficiency was improved by an average of 13 minutes per patient per review using the new system (p<0.001). The implementation of a computerized nutrition care process incorporating IDNT in the hemodialysis population resulted in improved efficiency without compromising nutrition-related outcomes.