Implementation of a hospital-based quality-improvement program targeting prolonged liquid-diet prescriptions in a tertiary hospital: A before-after study.

BACKGROUND AND AIMS: Prolonged use of liquid diets in hospitalized patients may contribute to inadequate caloric and protein intake, increasing the risk of hospital-acquired malnutrition. Evidence suggests that many liquid-diet prescriptions lack clear clinical justification. We evaluated the impact of an institutional quality-improvement program aimed at reducing prolonged liquid-diet exposure in a tertiary public hospital.

METHODS

A quasi-experimental before-and-after study without concurrent control grop was conducted using anonymized administrative data from adult patients admitted to medical and surgical areas of a public tertiary-level hospital, excluding intensive care units and postpartum units. The pre-intervention (January-March 2022) and post-intervention (October-December 2023) periods were compared. The program involved the identification of patients on prolonged liquid diets (>48 h) followed by bedside review and direct order modification by a multidisciplinary Nutrition Support Team.

RESULTS

We reviewed 3989 pre-intervention and 4339 post-intervention admissions. The proportion of admissions receiving liquid diets increased (15.0% vs. 23.7%), but mean liquid-diet duration decreased from 4.02 ± 3.36 to 2.99 ± 2.87 days (mean difference -1.03 days; 95% CI -1.35 to -0.71; p < 0.001). The proportion of prolonged liquid diets decreased from 53.9% to 40.6% (absolute difference -13.3 percentage points; 95% CI -18.3 to -8.2; p < 0.001). Supplementation among prolonged cases increased from 10.2% to 22.8% (absolute difference +12.6 percentage points; 95% CI + 7.4 to +17.8; p < 0.001). Exploratory model-based economic analyses projected potential net institutional savings under selected assumptions; however, these estimates were highly sensitive to assumed reductions in hospital length of stay. No patient-level clinical outcomes were measured.

CONCLUSION

Implementation of an active surveillance program may reduce the duration of exclusive liquid diets, increase the use of nutritional support, and may be associated with projected cost savings. These findings reflect improvements in institutional process indicators rather than direct evidence of clinical benefit. Although causal inference is limited and economic projections are exploratory, structured monitoring of dietary prescriptions may represent a feasible quality-improvement strategy in resource-limited hospital settings.