{
  "abstract": "Introduction Nutritional care of patients is becoming increasingly complicated, with associated multimorbidity, mental health issues and high-risk feeding needs that require coordinated specialist input. This complexity leads to longer hospital admissions and increased pressure on healthcare providers.There are MDMs for cancer, inflammatory bowel disease and basic nutrition, but MDMs for complex nutrition cases are uncommon and the benefits of complex nutrition MDMs are not well characterized.In 2021, a Complex Nutrition MDM was created at our trust to provide a structured forum for health professionals to review complex cases and agree upon safe personalised nutritional care plans. The MDM meets weekly and consists of gastroenterologists, dietitians, nurses and includes members of the eating disorders service and mental health liaison.Methods A cohort of patients discussed at the Complex Nutrition MDM was identified through clinic and inpatient electronic records. For each patient, clinical outcomes were reviewed over a four-year period, comparing the two years prior to any complex MDM discussion with the two years following it. Data collected included hospital activity, nutritional interventions, and operative outcomes. The primary endpoints were changes in mean and median length of hospital stay, while secondary analysis examined whether MDM review was associated with a reduction in emergency presentations. A qualitative survey was also conducted of MDM members. This approach enabled evaluation of both patient centred and service level impact of the MDM process.Results The total cohort analysed was 100 patients: 73 female and 27 male, with mean age of 43 years. Mean length of stay over two years reduced from 39.1 to 17 days (-56.5%) following MDM input and median stay reduced from 7 to 3 days (-57.1%). Total readmissions decreased from 210 to 181 (−13.8%), while elective admissions increased from 188 to 226 (+20.2%).Of 30 clinicians surveyed, 10 responded, all reporting improved patient management and increased confidence following MDM introduction. Overall feedback was strongly positive, with clinicians describing the MDM as extremely helpful and aiding links between teams. AHP relationship appeared very supported and positively affected.Conclusion The complex Nutrition MDM was associated with significant improvements in care coordination and healthcare resource utilisation. There was a marked reduction in length of hospital stay, possibly the result of improved and coordinated decision-making.There was also a reduction in readmission rates and an increase in elective rather than emergency appointments. This indicated a shift from less structured, unplanned interventions towards more proactive and planned care pathways.Overall, these findings suggest that a well-designed functioning Complex Nutrition MDM can enhance the quality, efficiency, and safety of care delivered. The reduction in length of stay contributes to improved patient flow.",
  "authors": [
    {
      "affiliations": [
        "East Sussex NHS Healthcare Trust, Hastings, United Kingdom"
      ],
      "name": "Steven Fong"
    },
    {
      "affiliations": [
        "East Sussex NHS Healthcare Trust, Hastings, United Kingdom"
      ],
      "name": "Katherine Howells"
    },
    {
      "affiliations": [
        "Masaryk University, Brno, Czech Republic"
      ],
      "name": "Abdul Rauf"
    },
    {
      "affiliations": [
        "East Sussex NHS Healthcare Trust, Hastings, United Kingdom"
      ],
      "name": "Christine Higgins"
    }
  ],
  "title": "P386 The complex nutrition MDM: collaborative care, concrete outcomes",
  "uid": "f505811e-cd55-55df-aaa5-4ae976436d59"
}