Selection of Patients and Timing of Nutritional Support

The process of nutritional support should be an integrated continuum from normal diet to EN based on a plan. This plan should be developed at the moment of each patient's entry and implemented with modifications until discharge. It is undesirable to have to make an urgent decision on a weekend after realizing that the patient has been starving for the previous 2 weeks. I favor an approach in which the nutritionist examines the needs of each patient at entry and follows the algorithm given in Figure 1.

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