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Academy for Quality and Safety Improvement (AQSI) project to improve diagnosis and documentation of malnutrition in a community hospital

BACKGROUND: Malnutrition is a significant public health problem that affects many patients in inpatient settings. Timely identification and addressing malnutrition in an inpatient setting presents an opportunity to improve patient care and reduce costs. There is a clear link between malnutrition, in...

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Autores principales: Parkash, Om, Jamil, Saad, Chudzinski, Valarie, Tahir, Nayha, Gole, Shrey, Deleon, Jacqueline, Forde, Cindy, Zahra, Farah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10603433/
https://www.ncbi.nlm.nih.gov/pubmed/37857522
http://dx.doi.org/10.1136/bmjoq-2023-002415
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author Parkash, Om
Jamil, Saad
Chudzinski, Valarie
Tahir, Nayha
Gole, Shrey
Deleon, Jacqueline
Forde, Cindy
Zahra, Farah
author_facet Parkash, Om
Jamil, Saad
Chudzinski, Valarie
Tahir, Nayha
Gole, Shrey
Deleon, Jacqueline
Forde, Cindy
Zahra, Farah
author_sort Parkash, Om
collection PubMed
description BACKGROUND: Malnutrition is a significant public health problem that affects many patients in inpatient settings. Timely identification and addressing malnutrition in an inpatient setting presents an opportunity to improve patient care and reduce costs. There is a clear link between malnutrition, increased length of hospital stay, higher risk of readmissions and infections, skin breakdown, and higher hospital costs due to complications. METHODS: We conducted a quality improvement project to increase the number of times patients were accurately diagnosed and successfully coded as malnourished. We used the Define, Measure, Analyse, Intervene, Control (DMAIC) process to complete this project. Data were collected for nearly a year using the Epic Report Tool developed explicitly for the project. Initial data showed that our hospital performed at 20% of patients diagnosed as malnourished, while the industry standard was 33%. A multidisciplinary team of physicians, nurses and dietitians identified critical areas of improvement, including incomplete nutritional assessments by nurses, delayed evaluations by dietitians and lack of documentation by physicians. We addressed these issues by partnering with nurse managers to provide education and individual accountability for missed screenings, expanding dietitian workflows to include an in-person assessment within 24 hours of consultation, and updating physician note templates to include smart phrases that automatically inserted nutritional evaluations from registered dietitians into notes. We also worked with hospital executives and administration to increase buy-in from participating care team members. RESULTS: Our interventions resulted in 100% of malnutrition screening tool being completed, 33% of patients being screened at risk of malnutrition, 98% of nutrition assessments being done within 24 hours of patient admission and 100% of providers documenting malnutrition findings. CONCLUSIONS: Our study found an immediate and significant increase in the number of times malnutrition was diagnosed and ultimately coded during billing with our interventions. This highlights the importance of timely identification and addressing malnutrition in an inpatient setting to improve patient care and reduce costs. The DMAIC process and multidisciplinary team approach proved to be effective in identifying and addressing the barriers to malnutrition diagnosis in our hospital setting.
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spelling pubmed-106034332023-10-28 Academy for Quality and Safety Improvement (AQSI) project to improve diagnosis and documentation of malnutrition in a community hospital Parkash, Om Jamil, Saad Chudzinski, Valarie Tahir, Nayha Gole, Shrey Deleon, Jacqueline Forde, Cindy Zahra, Farah BMJ Open Qual Quality Improvement Report BACKGROUND: Malnutrition is a significant public health problem that affects many patients in inpatient settings. Timely identification and addressing malnutrition in an inpatient setting presents an opportunity to improve patient care and reduce costs. There is a clear link between malnutrition, increased length of hospital stay, higher risk of readmissions and infections, skin breakdown, and higher hospital costs due to complications. METHODS: We conducted a quality improvement project to increase the number of times patients were accurately diagnosed and successfully coded as malnourished. We used the Define, Measure, Analyse, Intervene, Control (DMAIC) process to complete this project. Data were collected for nearly a year using the Epic Report Tool developed explicitly for the project. Initial data showed that our hospital performed at 20% of patients diagnosed as malnourished, while the industry standard was 33%. A multidisciplinary team of physicians, nurses and dietitians identified critical areas of improvement, including incomplete nutritional assessments by nurses, delayed evaluations by dietitians and lack of documentation by physicians. We addressed these issues by partnering with nurse managers to provide education and individual accountability for missed screenings, expanding dietitian workflows to include an in-person assessment within 24 hours of consultation, and updating physician note templates to include smart phrases that automatically inserted nutritional evaluations from registered dietitians into notes. We also worked with hospital executives and administration to increase buy-in from participating care team members. RESULTS: Our interventions resulted in 100% of malnutrition screening tool being completed, 33% of patients being screened at risk of malnutrition, 98% of nutrition assessments being done within 24 hours of patient admission and 100% of providers documenting malnutrition findings. CONCLUSIONS: Our study found an immediate and significant increase in the number of times malnutrition was diagnosed and ultimately coded during billing with our interventions. This highlights the importance of timely identification and addressing malnutrition in an inpatient setting to improve patient care and reduce costs. The DMAIC process and multidisciplinary team approach proved to be effective in identifying and addressing the barriers to malnutrition diagnosis in our hospital setting. BMJ Publishing Group 2023-10-19 /pmc/articles/PMC10603433/ /pubmed/37857522 http://dx.doi.org/10.1136/bmjoq-2023-002415 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Quality Improvement Report
Parkash, Om
Jamil, Saad
Chudzinski, Valarie
Tahir, Nayha
Gole, Shrey
Deleon, Jacqueline
Forde, Cindy
Zahra, Farah
Academy for Quality and Safety Improvement (AQSI) project to improve diagnosis and documentation of malnutrition in a community hospital
title Academy for Quality and Safety Improvement (AQSI) project to improve diagnosis and documentation of malnutrition in a community hospital
title_full Academy for Quality and Safety Improvement (AQSI) project to improve diagnosis and documentation of malnutrition in a community hospital
title_fullStr Academy for Quality and Safety Improvement (AQSI) project to improve diagnosis and documentation of malnutrition in a community hospital
title_full_unstemmed Academy for Quality and Safety Improvement (AQSI) project to improve diagnosis and documentation of malnutrition in a community hospital
title_short Academy for Quality and Safety Improvement (AQSI) project to improve diagnosis and documentation of malnutrition in a community hospital
title_sort academy for quality and safety improvement (aqsi) project to improve diagnosis and documentation of malnutrition in a community hospital
topic Quality Improvement Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10603433/
https://www.ncbi.nlm.nih.gov/pubmed/37857522
http://dx.doi.org/10.1136/bmjoq-2023-002415
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