An Email Intervention to Prevent Iatrogenic Malnutrition in the ICU

This is a quality improvement research project evaluating if a targeted feedback email to clinicians impacts their nutrition delivery in the ICU.

Study Overview

• Status: Completed
• Conditions: Malnutrition
• Intervention / Treatment: Other: Feedback/Reminder email.

Detailed Description

This prospective study looks to determine if a targeted email to clinicians taking care of critically ill patients will allow reduce malnutrition in the Intensive Care Units (ICU). Four ICUs will be included: medical ICU (MICU), coronary care unit (CCU) and two surgical ICUs. The investigators will rotate a 2 month period intervention amongst the aforementioned participating ICUs and follow simultaneous cohorts to evaluate the effect of our intervention (email feedback to treating clinicians) on nutrition delivery in the ICU. After the completion of the intervention, there will be a six-month follow-up of nutritional adequacy to assess the durability of changes in behavior.

• Study Type: Interventional
• Enrollment (Actual): 197
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Clinicians taking care of patients admitted to the ICU within the past 48hrs
• Clinicians taking care of patients in whom enteral nutrition is prescribed

Exclusion Criteria:

• Clinicians taking care of patients in whom enteral nutrition is not prescribed.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: E-mail intervention; ICU clinicians caring for patients who have not yet been initiated on nutrition 48 hours after ICU admission will receive a reminder email. ICU clinicians caring for patients who accumulate a caloric deficit greater than 4000 calories or 150 g protein deficit will receive a feedback email	Other: Feedback/Reminder email.
No Intervention: No E-mail intervention; Nutrition status of patients will be assessed but no reminder or feedback emails will be sent

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patients started on nutrition within 72 h of ICU admission	The ICU admission date and EN initiation date will be collected in a data base which will later be analyzed to assess the percentange of patients initiated on EN within 72 hours of admission to the ICU. This will be reported as rates and will be compared amongst intervention and no-intervention arms using Fisher's Exact test or Chi-sq Test	After completing the intervention for each ICU (2 months)

Collaborators and Investigators

• Sponsor: Massachusetts General Hospital

Study record dates

Study Major Dates

• Study Start: December 1, 2014
• Primary Completion (Actual): April 1, 2015
• Study Completion (Actual): April 1, 2015

Study Registration Dates

• First Submitted: October 27, 2014
• First Submitted That Met QC Criteria: October 28, 2014
• First Posted (Estimate): October 29, 2014

Study Record Updates

• Last Update Posted (Estimate): February 2, 2017
• Last Update Submitted That Met QC Criteria: January 31, 2017
• Last Verified: January 1, 2017

More Information

Terms related to this study

• Keywords: Malnutrition in the ICU (caloric deficit >4000 kcal or 150 g protein deficit) or >48hrs of admission without receiving nutrition
• Additional Relevant MeSH Terms: Nutrition Disorders; Malnutrition
• Other Study ID Numbers: 2014P001702