Clinical Nutrition Management Status in Convalescent Hospitals Before and After Healthcare Accreditation Process

Abstract

The increasing elderly population has created an urgent need for well-managed convalescent hospitals, which should provide appropriate clinical nutrition services. The new accreditation policy requiring participation of all convalescent hospitals since 2013 may promote improvement of clinical nutrition services. This study examined whether or not the accreditation policy has increased practice level and dietitians' perception of the importance of clinical nutrition management. Of the 177 convalescent hospitals accredited by January 30, 2014, dietitians from 73 hospitals (41.2%) completed the survey questionnaire. The pre-tested questionnaire surveyed general characteristics of the hospital and dietitians, current status of clinical nutrition management, and changes in the perception and practice levels of various aspects of food and clinical nutrition management. In average, dietitians with more than 5 years of work experience (68.1%) provided food and clinical nutrition services (71.2%). After accreditation, dietitians' perception of the importance and practice level of clinical nutrition service increased (P＜0.001). Level of perception, however, was significantly (P＜0.001) higher than practice level before and after accreditation. During perception and practice level of initial nutrition assessment, a compulsory accreditation item, notably and significantly (P＜0.001) improved after accreditation. The significant difference between perception and practice level disappeared after accreditation. In conclusion, the accreditation process had positive effects on clinical nutrition management in terms of dietitians' perception and practice levels. Making more accreditation items compulsory and providing motivation and professional education to dietitians in convalescent hospitals could lead to additional improvements.

Dietitians View of Foodservice Sanitary Practices and Demands in Long-Term Care Hospitals

“…Despite the practical implications, this study has few limitations. Since the number of respondents in this study was relatively small compared to prior studies [ 5 15 23 34 35 ], it is difficult to generalize to all long-term care hospital. Nevertheless, the significance of this study is that we identified the level of performance during foodservice management by dietitians, and we ensured that most of the dietitian wanted a structured manual for the improvement of their practice.…”

“…In particular, elderly people who use long-term care hospitals often have chronic diseases that require continuous medical care. Unlike acute care hospitals, many elderly people are hospitalized for management of disease rather than for active treatment of disease [ 4 5 6 ]. Most of the patients and are at high risk of infection in environments prone to exposed pathogens due to physical aging, such as chronic diseases and reduced recovery ability [ 7 8 ].…”

“…Even acute care hospitals have difficulties in meeting the standards and guidelines for preparation Healthcare Accreditation Program [ 12 ] despite having experienced professionals [ 13 ]. Let alone, long-term care hospitals are expected to have more difficulties as they are often smaller in size or lack manpower and resources than acute care hospital [ 5 ]. According to previous studies [ 5 14 ], depending on the hospital size of long-term care hospitals, they normally have low priority in foodservice management compared to general and tertiary hospital as a result of small kitchen, dish-washing using hand, no partition wall from contamination zone in the hospital.…”

“…Let alone, long-term care hospitals are expected to have more difficulties as they are often smaller in size or lack manpower and resources than acute care hospital [ 5 ]. According to previous studies [ 5 14 ], depending on the hospital size of long-term care hospitals, they normally have low priority in foodservice management compared to general and tertiary hospital as a result of small kitchen, dish-washing using hand, no partition wall from contamination zone in the hospital. More than 70% of dietitians in long-term care hospitals were in charge of both foodservice and clinical nutrition, and more than 60% of respondents said they needed to separate their duties, indicating the lack of manpower.…”