Avalere Health
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Sep 27, 2016

Improving Patient Outcomes by Reducing Clinical Practice Variability in Malnutrition Care

For Malnutrition Awareness WeekTM, Avalere will be releasing a series of podcasts focused on new tools developed by the Malnutrition Quality Improvement Initiative (MQii) – a collaboration of the Academy of Nutrition and Dietetics, Avalere Health, and other organizations dedicated to improving nutrition care.

Tune in as Michelle Bruno, senior manager at Avalere, discusses the implementation of a new MQii Toolkit across hospital departments at Vanderbilt University Medical Center with Dr. Heidi Silver, Ph.D., R.D., Research Associate Professor of Medicine and Director of the Vanderbilt Diet, Body Composition, and Human Metabolism CORE. The MQii Toolkit provides practical, interdisciplinary tools and resources to help hospitals implement malnutrition best practices across all aspect of malnutrition care (e.g., screening, assessment, diagnosis, discharge planning). Dr.Silver will also highlight quality improvement opportunities and lessons learned for hospitals interested in using the MQii Toolkit in the future.

[TRANSCRIPT]

Michelle (Moderator): 

Welcome to today’s discussion.  I am Michelle Bruno, a Senior Manager at Avalere Health and a contributor to the Malnutrition Quality Improvement Initiative (MQii) – a collaboration of the Academy of Nutrition and Dietetics, Avalere Health, and other organizations dedicated to improving nutrition care. Joining me today to talk about the MQii and implementation of its tools is Dr. Heidi Silver. She is an Associate Professor at Vanderbilt University Medical Center in the Division of Gastroenterology, Hepatology and Nutrition, and the Director of the Vanderbilt Diet, Body Composition, and Human Metabolism Core Lab. The Medical Center served as the primary demonstration site that tested the MQii Toolkit . Thank you, Dr.Silver for joining Avalere on the Podcast today and for embarking on the MQii journey with us. I’ll begin with my first question.

Moderator - Michelle:

The MQii tool was intended to be used with a multidisciplinary team of physicians, nurses, dietitians, and other hospital staff.  Can you tell us how implementation of MQii achieved communication or coordination among these different staff to improve malnutrition care? Where there any challenges in getting a multidisciplinary staff to work together to enhance malnutrition care? 

Guest speaker reply- Heidi:

I think that being that we are an academic medical center, we are used to working together in a multidisciplinary format. But this project implementing the MQii provided an opportunity to incorporate dieticians more in the nursing care process, for example, the change of shift hand-offs, and the team huddles that nurses have. And it also provided an opportunity to include malnutrition attention more in the daily physician rounds that led to greater discussion of the potential for malnutrition in patients and in units that we implemented the toolkit.

Moderator - Michelle:

Once your care teams were educated on the importance of malnutrition and the best practices for optimal care outlined in the MQii Toolkit, where did you see the greatest improvement in your malnutrition care processes? 

Guest speaker reply - Heidi:

So, we saw three particular areas where there were significant improvement. One was in the time between a patient being screened for malnutrition risks and having a diet order that was appropriate for someone who is at or already has malnutrition. The second was in the consistency between having a dietician diagnose malnutrition and physicians diagnosing malnutrition….so closing that gap. And the third was in the consistency in which the dietician’s intervention for malnutrition care was incorporated into the discharge plan.

Moderator - Michelle:

Those are 3 very important areas. Can you tell us about the impact these important changes had on your patients? Did you see patient outcomes in the different units improve as a result of these changes in your malnutrition care processes?

Guest speaker reply - Heidi

We don’t have hard data yet on patient outcomes. But it seems apparent from what we’ve observed that the consistency of the diagnosis led to improvement in the orders being written for the recommendations from the dietitians, and a more comprehensive and adequate intervention with regard to patients malnutrition and their risks for malnutrition. And that also continues in the entire care continuum into the discharge plan now, where in the past the malnutrition care might have been overlooked in the discharge process.

Moderator - Michelle:

And do you mind sharing just a little bit about what your discharge planning entails now for malnutrition care?

Guest speaker reply – Heidi

I think there is more incorporation of communications between the nurses who are formulating the plan and the social workers and other care givers with the dietician and the orders that have been written for malnutrition care. So, I think it’s not a hard outcome that we can measure directly, but it’s a lot greater attention and awareness and inclusion.

That’s fantastic. Thank you so much Dr. Silver for sharing your experiences with us today. It’s helpful to know how the MQii Toolkit helped your facility improve care processes and coordination.  We’re excited to make it available.  So we appreciate everything you are doing to help give malnutrition care the attention it deserves. 

For those that would like to learn more about optimal practices for malnutrition care and what you can do to improve malnutrition care for your patients, please visit the MQii web page at mqii.today. Thank you so much.

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