Joint Commission for Accreditation of Health Care Organizations guidelines: too late to intervene for nutritionally at-risk surgical patients

Abstract

BACKGROUND: Joint Commission for Accreditation of Health Care Organizations (JCAHO) guidelines recommend nutritional screening within 24 hours of hospital admission, with full nutrition assessment if at-risk. This study examines whether these guidelines detect surgical patients who may benefit from preoperative nutrition support. METHODS: A retrospective chart review was conducted for patients undergoing nonemergent esophageal, gastric, pancreatic, or colon surgery between 1996 and 2001 to determine dates of admission, day of surgery, and timing of documented nutrition screening and assessment. RESULTS: Most patients undergo surgery within 24 hours of admission, and undergo initial screening or full assessment after surgery. Twenty percent of patients are admitted for diagnostic testing, preoperative cardiovascular workup, or medical management preoperatively and are assessed 5 to 6 days before surgery, but these are the minority. CONCLUSION: Because of the high incidence of nonemergent surgeries that occur within 24 hours of admission, screening and assessment by JCAHO guidelines cannot detect patients who may benefit from preoperative nutrition support. Systems to identify these patients must be implemented earlier in nutrition screening and assessment.

The current Joint Commission for Accreditation of Health Care Organizations guidelines do not allow early identification of malnourished patients who might benefit from preoperative nutrition support because such a large number of them undergo surgery on the day of admission.