Perceptions on Use of the Subjective Global Assessment Before and After It Became Part of Regular Practice

Abstract

Background: Subjective global assessment (SGA) is a standardized diagnostic tool for malnutrition and identifies those who would benefit from nutrition treatment. SGA has been validated in several patient populations; however, implementation in clinical practice is inconsistent. The objective of this study was to understand and contrast the perceptions on use of SGA before and after it became a regular practice for hospital dietitians. Methods: The More-2-Eat implementation project provided the opportunity to undertake this qualitative study, as 5 hospitals adopted INPAC (Integrated Nutrition Pathway for Acute Care), which includes the use of SGA. Between 2015 and 2018, interviews were conducted with dietitians at baseline (n = 9), a year after implementation (n = 18), and a year after project completion (n = 6). Thematic analysis was conducted. Results: Themes before SGA adoption included a desire for a malnutrition diagnosis and care planning; lacking comfort in use of SGA; and reflecting on SGA training needs.After a year of implementing INPAC and a year after project completion, themes described becoming a better clinician; allowing dietitians to see the right people, sooner; recognizing the variability in the treatment path for mildly/moderately malnourished (SGA B) patients; improving overall efficiency in delivery of care; and establishing policy and procedures to sustain and spread use of SGA. Conclusion: Initially, dietitians were hesitant to use SGA. Adoption through a focused implementation study and experience with implementation of SGA changed these perceptions. Understanding these perceptions before and after use may support adoption of this useful diagnostic tool. (Nutr Clin Pract. 2019;34:906-915)

What Internists Should Know about Malnutrition in Hospitalized Patients

“…For practical clinical application, the CMTF recommends diagnosing malnutrition with a bedside nutrition assessment tool, subjective global assessment (SGA), that can be performed by any trained provider (including physicians) with a registered dietitian (RD). 6 The SGA is a comprehensive assessment and scoring system that includes details of the patient's nutritional intake, weight, symptoms, functional capacity, and physical examination (Figure 1). 7…”

Evaluation of Nutrition Status Using the Subjective Global Assessment: Malnutrition, Cachexia, and Sarcopenia

“…The CMTF has incorporated the use of the SGA into an algorithm, the Integrated Nutrition Pathway for Acute Care 12 for the detection and management of malnutrition in Canadian hospitals. A recent analysis on the perception of using SGA in regular practice reveals its ability to identify malnourished patients sooner and improve overall efficiency in delivery of nutrition care 13 …”

“…A recent analysis on the perception of using SGA in regular practice reveals its ability to identify malnourished patients sooner and improve overall efficiency in delivery of nutrition care. 13 Individuals with experience using and teaching SGA have identified common difficulties in interpreting SGA, such as determining causes of muscle wasting, that are not well addressed with current guides. In fact, as the physical examination is now an integral part of the nutrition evaluation, the clinician is regularly called on to identify patients with loss of muscle mass.…”

Trends and Novel Research in Hospital Nutrition Care: A Narrative Review of Leading Clinical Nutrition Journals

“…Twelve articles, [29][30][31][32][33][34][35][36][37][38][39][40] including 1 intervention study 30 and 1 systematic review, 29 discussed novel aspects of nutrition assessment. The European Society of Parenteral and Enteral Nutrition (ESPEN) 39 and Global Leadership Initiative on Malnutrition (GLIM) proposed diagnostic criteria for malnutrition.…”

“…Gaps in nutrition assessment practice were shown to persist, 34 including lack of referral to dietitians for malnourished patients or for those eating ≤50% of hospital food 36 . Dietitian practice for identifying, documenting, and coding malnutrition, 31 as well as performing a physical examination, 31,37 was noted as an area for improvement. Understanding dietitian hesitancy to conduct physical exams could help design training approaches to support practice change 37 that may include the use of the Subjective Global Assessment by allied health assistants 30 …”