Acute-Care Hospital Discharge Summary of Patients with Feeding-Tube Admitted to a Long Term Rehabilitation Center

Nutritional care of patients fed with a feeding-tube is critical for the quality of care and for preserving life by insuring adequate intake of nutrients. The presence of a nutritional plan in hospital discharge is necessary for the continuum of care and ensuring that the necessary needs are met until a new assessment is made according to the patient status. The nutritional plan can be reported in the discharge summary by the physician, the nurse, or the dietician.

We examined the presence of a nutritional plan in the acute-care discharge summaries of patients admitted with a feeding-tube to our rehabilitation medical center during 2015-17. The quality of the nutritional plan was also evaluated by the 1) presence of key elements that are necessary for initiating nutritional care in the subsequent care setting following discharge from an acute-care hospital, 2) in case of multiple nutritional plans per patients, the extent of concordance in key nutritional elements.

We identified 100 acute-care discharge summaries for 88 patients presenting with a feeding-tube upon admission to our rehabilitation center. Median age at time of admission to our rehabilitation center was of patients was 71 (54-82), with 54% males. Among the 100 summaries, 91 had at least 1 nutritional plan. Those with (N=91) and without nutritional plan (N=9) had low hemoglobin levels (86.8% and 88.9% with anemia, respectively) and low albumin (68.1% and 44.5% with albumin<3.5 g/dL respectively). The 91 summaries with at least 1 nutritional plan yielded a total number of nutritional plans reaching 165. Key elements comparison in summaries with multiple plans showed a wide range of concordance between medical staff (0-100%).

Our results show that not all tube-fed patients arrive to the rehabilitation setting with a nutritional plan in the acute-care discharge summary. Efforts should be made to assure the presence of a nutritional plan in the acute-care discharge summary and improve its quality.