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other·clinical nutrition, internal medicine, nutrition, research methods·PMC10490138

Development, Design and Utilization of a CDSS for Refeeding Syndrome in Real Life Inpatient Care—A Feasibility Study

Nutrients · 11 authors, 5 centres

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TL;DR

False positives were often due to other medical conditions causing similar electrolyte imbalances.

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False positives were often due to other medical conditions causing similar electrolyte imbalances. A short questionnaire revealed that many attending physicians were unfamiliar with RFS or its diagnostic criteria. The study provides proof of concept for a CDSS to improve RFS recognition in clinical practice, highlighting a significant educational need among physicians.

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other

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clinical nutrition

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ORIGINAL PAPER

PMC10490138

Development, Design and Utilization of a CDSS for Refeeding Syndrome in Real Life Inpatient Care—A Feasibility Study

Nutrients

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ABSTRACT

Abstract Background: The refeeding syndrome (RFS) is an oftentimes-unrecognized complication of reintroducing nutrition in malnourished patients that can lead to fatal cardiovascular failure. We hypothesized that a clinical decision support system (CDSS) can improve RFS recognition and management. Methods: We developed an algorithm from current diagnostic criteria for RFS detection, tested the algorithm on a retrospective dataset and combined the final algorithm with therapy and referral recommendations in a knowledge-based CDSS. The CDSS integration into clinical practice was prospectively investigated for six months. Results: The utilization of the RFS-CDSS lead to RFS diagnosis in 13 out of 21 detected cases (62%). It improved patient-related care and documentation, e.g., RFS-specific coding (E87.7), increased from once coded in 30 month in the retrospective cohort to four times in six months in the prospective cohort and doubled the rate of nutrition referrals in true positive patients (retrospective referrals in true positive patients 33% vs. prospective referrals in true positive patients 71%). Conclusion: CDSS-facilitated RFS diagnosis is possible and improves RFS recognition. This effect and its impact on patient-related outcomes needs to be further investigated in a large randomized-controlled trial. Keywords: refeeding syndrome, CDSS, clinical nutrition, computerized decision support system, malnutrition, diagnostic support

CITATION EXPORT

Lara Heuft, Jenny Voigt, Lars Selig et al.. Development, Design and Utilization of a CDSS for Refeeding Syndrome in Real Life Inpatient Care—A Feasibility Study. Nutrients. (2023). https://doi.org/10.3390/nu15173712

AUTHORS

11 · 5 CENTRES

Lara Heuft, Jenny Voigt, Lars Selig, Maria Schmidt, Felix Eckelt, Daniel Steinbach, Martin Federbusch, Michael Stumvoll, Haiko Schlögl, Berend Isermann, Thorsten Kaiser

1Institute of Human Genetics, University Medical Center Leipzig, 04103 Leipzig, Germany
2Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Medical Center Leipzig, 04103 Leipzig, Germany
3Department of Endocrinology, Nephrology and Rheumatology, University Medical Center Leipzig, 04103 Leipzig, Germany
4Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at University Medical Center Leipzig, 04103 Leipzig, Germany
5Institute for Laboratory Medicine, Microbiology and Pathobiochemistry, Medical School and University Medical Center OWL, Hospital Lippe, Bielefeld University, 32756 Bielefeld, Germany