A dietitian collaborates with a clinicianMount Carmel Health System upgraded its admission screening process to identify malnourished patients.

 

Providers can increase identification of malnourished patients by 30 percent with the use of a reliable screening tool, which can improve quality of care and reduce costs, according to a study published in the American Journal of Clinical Nutrition

Recognizing this, Mount Carmel Health System, Columbus, Ohio, is identifying patients who are malnourished— or at risk of becoming so—early in the admission process. An admitting nurse completes a nutrition screening within 24 hours of admission, ensuring that patients with nutritional needs receive quick intervention. Prompt treatment of malnourished patients has been linked to shorter lengths of stay, lower hospital costs, and reduced readmission rates (see the exhibit below).  

Impact of Oral Nutrition Supplements During Hospitalization

Improving the Screening Process 

Mount Carmel’s original screening method was not reliably identifying patients with nutritional deficiencies. As a result, nurses began using a new three-question malnutrition screening tool designed for clinicians who don’t have a background in nutrition. Nurses ask admitted patients the following questions: 

  • Have you recently lost weight without trying?
  • If you have lost weight without trying, how much weight have you lost?
  • Have you been eating poorly because of a decreased appetite?

The patient’s responses are recorded and scored in the electronic health record (EHR), which produces an automatic referral to a clinical dietitian for patients at high risk for malnutrition.

Ensuring Policy Compliance

Patients who are referred to a clinical dietitian receive a comprehensive nutrition assessment. The dietitian and the patient’s physician then determine the appropriate nutrition intervention strategy. Ongoing monitoring continues throughout the patient’s stay. 

Nutrition intervention for hospital patients can occur in several ways based on the patient’s clinical condition. It is not uncommon for dual methods to be occurring simultaneously. The first option is optimizing nutrition through food eaten by patients during meals. For some patients, it is necessary to provide an oral nutrition supplement, while others must undergo enteral tube feeding or parenteral nutrition.

Improving Outcomes

Malnutrition is a critical problem in hospitalized patients. Ensuring that at-risk patients are screened within 24 hours of admission with a reliable screening tool and that malnourished patients are referred to clinical dietitians can improve clinical and financial outcomes. 


Ainsley Malone, RD, CNSC, LD, is nutrition support dietitian, Mount Carmel West Hospital, Columbus, Ohio, and president of the American Society for Parenteral and Enteral Nutrition. She is a founding clinician member of the Alliance to Advance Patient Nutrition.

Publication Date: Thursday, October 17, 2013