Maine Medical Center, Medical Education, Maine Medical Center Research Institute
Nutritional Assessment, Mass Screening, Malnutrition
Background: At a tertiary care hospital, a one day audit was completed by the registered dietitians (RD) via chart review in February of 2018. Results showed that 12% of patients were identified to have a nutritional risk factor on admission screen, but were not referred to the dietitian. The purpose of this Quality Improvement initiative was to track outcomes following the implementation of a new nutrition screening tool (MST) in the acute care setting in an efficient way utilizing embedded features in the electronic medical record (EMR) and the expertise of data analysts in an effort to capture more referrals for the patients deemed to be at nutritional risk.
Methods: A validated nutrition screening tool was implemented in January 2019 to be completed on admission. The Malnutrition Screening Tool (MST) was selected based on the available evidence as it was shown to be both valid and reliable. A Best Practice Advisory (BPA), which is an alert built into the EMR, prompted nursing staff to enter a nutrition consult, if indicated. The nutrition support team collaborated with data analysts to develop a report in the EMR system to monitor outcomes of implementing the screening tool. Outcomes included percentage of patients with MST completed on admission, percentage of patients identified at nutrition risk cuing a BPA, and of the patients identified at nutrition risk, how many received a nutrition consult. Furthermore, the report indicated if the RD identified malnutrition as a result of the consult, if malnutrition was put on the problem list, and if malnutrition was a coded diagnosis after discharge. The data analyst created a report which could be run for any specified time frame.
Results: With 25,709 patients discharged between the date of implementation January 2019 and January 2020, the MST was completed on 24,487 (95.2%) of those patients. Of those with MST completed, 3,027 (11.8%) were found to be at nutrition risk. Nutrition services received a consult for 2,844 (94%) of those patients. Upon further review, 576 (19 %) of the patients who had a nutrition consult resulting from the MST had a form of malnutrition documented by the RD in the chart and 651 (21.5%) went on to have malnutrition included in the final diagnosis. To date, since implementing the MST, the rate of patients who are identified as being at nutritional risk but not referred has decreased by 60%, from 12% to 4.5%.
Conclusion: Implementation of a validated screening tool as well as utilizing features embedded in the EMR can improve the number of referrals of patients identified at nutrition risk. Collaboration between RD and data analysts can result in efficient ways to monitor outcomes of a quality improvement project such as implementation of a new screening tool. Having an effective report such as this can help target future QI efforts to close the gap of missed referrals and help identify malnutrition.
Edwards, Rebecca and Blakeslee, Paul, "Evaluating Efficacy of a Recently Implemented Malnutrition Screening Tool" (2020). Costas T. Lambrew Research Retreat 2020. 108.