SummaryOn March 25, the British Medical Journal Open Quality published an article, “Impact of an Interdisciplinary Malnutrition Quality Improvement Project at a Large Metropolitan Hospital,” co-authored by Kelsey Jones and Kristi Mitchell.
The article reflects the interventions undertaken by Tampa General Hospital (TGH), a large teaching hospital in the southeastern US, to improve the quality of care for patients who were malnourished or at-risk of malnutrition at its institution. TGH used resources from the Malnutrition Quality Improvement Initiative (MQii), a national program led by Avalere Health and the Academy of Nutrition and Dietetics, to guide their efforts.
TGH recognized the importance of high-quality malnutrition care, given that up to 50% of hospitalized patients are estimated to be malnourished or at risk of malnutrition upon hospital admission, but this condition often goes unrecognized, undiagnosed, and untreated. Malnutrition is associated with an elevated need for continued medical interventions, higher costs of care, and increased patient safety risks. A review of their own data identified opportunities to better identify and manage malnourished and at-risk patients at TGH.
The structure of the MQii and the use of the MQii Toolkit helped staff members identify problems and systematically engage in quality improvement processes. Using the MQii Toolkit, TGH implemented a multi-pronged approach to improving the treatment of malnourished patients that involved creating interdisciplinary teams of staff and adopting a series of changes to hospital-wide clinical workflows, including increased dietitian engagement, better use of electronic health record alerts, and new surgical protocols. Following implementation of these quality improvement processes, TGH patients who were malnourished or at risk of malnutrition had a 25% reduction in length of stay (from 8 to 6 days, p<0.01) and a 35.7% reduction in infection rates (from 14% to 9%, p<0.01).
This study adds to a growing body of literature on quality improvement processes hospitals can undertake to better identify and treat malnourished patients. Hospitals and health systems can benefit from adopting similar institution-wide, quality improvement projects, while policymaker support for such programs can spur more rapid uptake of nutrition-focused initiatives across care delivery settings.
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