The report is a product of the VA/HSR Evidence Synthesis Program.

Automated Nutrition Delivery: A Systematic Review

Takeaway: Automating nutritional support delivery for hospitalized patients offers a way to maximize safety and quality as it standardizes and documents ordering, administering, and monitoring of essential nutritional supports while reducing medical errors and hospital staff time to order nutritional products. The results of this systematic review show generally positive process, performance, and patient outcomes associated with implementing some form of automated nutrition support delivery to hospitalized patients. However, results should be interpreted with caution due to limitations of the literature. Study authors also conducted qualitative interviews with VHA staff who had experience with automating nutrition delivery. Overall, staff expressed positive experiences with automating nutrition delivery and provided insights into common implementation barriers and facilitators associated with this innovation in a hospital setting.

Hospital malnutrition is a common condition that often goes undiagnosed and untreated. Automating nutritional support delivery for hospitalized patients through innovations such as computerized entry systems or barcodes on patient-specific wristbands offers a way to maximize safety and quality as it standardizes and documents ordering, administering, and monitoring of essential nutritional supports while reducing medical errors and hospital staff time to order nutritional products. Yet, it is unknown which forms of automation are optimal, to what degree automation optimizes key clinical and patient outcomes, and how hospital staff who implement and deliver nutrition supports experience such automation innovations.

In response to a request from the VHA Nutritional Field Advisory Board, HSR’s Evidence Synthesis Program (ESP) Center in Durham, NC, conducted a systematic review of literature on the impact of automated nutrition delivery systems in the context of inpatient care. The ESP team also interviewed 12 VHA employees across four VA healthcare systems who had interacted with or participated in implementation of automated nutrition delivery supports.

To identify relevant articles, an expert medical librarian searched MEDLINE, Embase, and CINAHL from inception to January 16, 2022. The databases were searched using a combination of database-specific controlled vocabulary terms and keywords in the titles and abstracts related to nutrition delivery.

To be included in this review, nutritional supports could have been delivered through any route: oral, enteral (through an opening into the digestive system), or parenteral (through a vein). The ESP team defined automation of nutrition delivery as a process or use of technology to deliver hospital-based nutrition to patients that minimizes human involvement. Relevant studies needed to include at least one of the following aspects of automation: trigger of documentation of any step starting at nutritional assessment through termination of supplementation; ordering nutrition supports; or delivery of nutrition supports.

Summary of Findings

• Sixteen studies assessed the impact of automated nutrition delivery on healthcare delivery and patient outcomes. No published relevant studies explored staffs’ qualitative experiences of implementing automated nutrition support innovations.
• Most studies that assessed the impact of automated nutrition delivery were conducted with pediatric populations and examined automating the ordering of nutrition, alone or in combination with other automation or decision support tools.
• Most studies reported improvements in patient, process, and performance outcomes associated with implementation of some form of automated nutrition delivery to hospitalized patients. Yet, available evidence for key outcomes was rated as very low certainty due to methodological limitations of the included studies.
• Findings from qualitative interviews with VHA staff who had used some type of automated nutrition delivery innovation revealed common perceived and experienced implementation barriers and facilitators. Overall, staff expressed positive impressions of how automated nutrition innovations can improve patient care, safety, and staff satisfaction.

Implications

Findings indicate that implementation of automated nutrition delivery in a hospital setting is a multidisciplinary effort that requires robust education and training across hospital service lines prior to implementation, and ongoing training to sustain successful outcomes and support collegial collaboration across involved staff.

Limitations

Most of the included studies were low quality and had considerable bias concerns. As nearly 70% of the literature centered on automating nutrition support delivery among hospitalized children, it is unclear whether the findings would translate to hospitalized adults. Heterogeneity across included studies limited the ESP team’s ability to draw strong conclusions about which type of automated nutrition delivery innovation works best for what setting or hospitalized patient populations, and wide variation in the studies’ outcomes and interventions limited the ESP team’s ability to conduct meta-analysis.

Future Research

Future implementation studies should examine how hospital staff experience automated nutrition delivery innovations. Studies should also examine the impact of automated nutrition delivery innovations within adult populations; evaluate medication administration record innovations; and compare different enhancements to computerized provider order entry (CPOE; e.g., CPOE + decision support versus CPOE + integrated calculator).

Citation:

Starr K, Myer E, Boggan JC, et al. Automated Nutrition Delivery: A Systematic Review. Washington, DC: Evidence Synthesis Program, Health Systems Research, Office of Research and Development, Department of Veterans Affairs. VA ESP Project # 09-010; 2025.

To view the full report, go to vaww.hsrd.research.va.gov/publications/esp/automated-nutrition.cfm . (This report is available via Intranet only.)

How can VA leadership work with the ESP? Nominations for systematic review topics may be submitted to the program at any time. When you submit a topic nomination form, ESP Coordinating Center staff will work with you to determine the appropriate research approach and ESP product to address your questions of interest. Topics are selected and assigned to an ESP Center based on program capacity and alignment with VA national goals.

This Management Brief is provided to inform you about recent HSR findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR Resource Center charged with disseminating important HSR findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.

This report is a product of VA/HSR's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers; and to disseminate these reports throughout VA.

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