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Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital

As many as 50% of hospitalised patients are estimated to be malnourished or at risk of malnutrition on hospital admission, but this condition often goes unrecognised, undiagnosed and untreated. Malnutrition is associated with an elevated need for continued medical interventions, higher costs of care...

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Autores principales: Pratt, Kelsey Jones, Hernandez, Beverly, Blancato, Robert, Blankenship, Jeanne, Mitchell, Kristi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170540/
https://www.ncbi.nlm.nih.gov/pubmed/32213547
http://dx.doi.org/10.1136/bmjoq-2019-000735
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author Pratt, Kelsey Jones
Hernandez, Beverly
Blancato, Robert
Blankenship, Jeanne
Mitchell, Kristi
author_facet Pratt, Kelsey Jones
Hernandez, Beverly
Blancato, Robert
Blankenship, Jeanne
Mitchell, Kristi
author_sort Pratt, Kelsey Jones
collection PubMed
description As many as 50% of hospitalised patients are estimated to be malnourished or at risk of malnutrition on hospital admission, but this condition often goes unrecognised, undiagnosed and untreated. Malnutrition is associated with an elevated need for continued medical interventions, higher costs of care and increased patient safety risks. Tampa General Hospital (TGH), a large teaching hospital in the southeastern USA, initiated a project to improve the quality of patient care at its institution. They did this first by focusing on improving the care quality for their malnourished patients (or patients who were at risk of malnourishment) and by using elements of the national Malnutrition Quality Improvement Initiative (MQii) Toolkit as a mechanism to measure and improve quality. The aim of this study was to evaluate the impact of quality improvement interventions on patient length of stay (LOS), infection rates and readmissions, particularly for malnourished patients. 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 multipronged approach to improving the treatment of malnourished patients that involved creating interdisciplinary teams of staff and identifying gaps in care that could be improved through a series of changes to hospital-wide clinical workflows. They enhanced interdisciplinary coordination through increased dietitian engagement, the use of electronic health record alerts and new surgical protocols. These interventions lasted 8 months in 2016 and data reported here were collected from 985 patients before the interventions (2015) and 1046 patients after the interventions (2017). The study examines how these process changes affected LOS, infection rates and readmissions at TGH. Following implementation of these quality improvement processes, patients who were malnourished or at risk of malnutrition had a 25% reduction in LOS (from 8 to 6 days, p<0.01) and a 35.7% reduction in infection rates (from 14% to 9%, p<0.01). No statistically significant changes in readmission rates were observed. 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 policy-makers’ support for such programmes can spur more rapid uptake of nutrition-focused initiatives across care delivery settings.
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spelling pubmed-71705402020-04-24 Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital Pratt, Kelsey Jones Hernandez, Beverly Blancato, Robert Blankenship, Jeanne Mitchell, Kristi BMJ Open Qual Quality Improvement Report As many as 50% of hospitalised patients are estimated to be malnourished or at risk of malnutrition on hospital admission, but this condition often goes unrecognised, undiagnosed and untreated. Malnutrition is associated with an elevated need for continued medical interventions, higher costs of care and increased patient safety risks. Tampa General Hospital (TGH), a large teaching hospital in the southeastern USA, initiated a project to improve the quality of patient care at its institution. They did this first by focusing on improving the care quality for their malnourished patients (or patients who were at risk of malnourishment) and by using elements of the national Malnutrition Quality Improvement Initiative (MQii) Toolkit as a mechanism to measure and improve quality. The aim of this study was to evaluate the impact of quality improvement interventions on patient length of stay (LOS), infection rates and readmissions, particularly for malnourished patients. 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 multipronged approach to improving the treatment of malnourished patients that involved creating interdisciplinary teams of staff and identifying gaps in care that could be improved through a series of changes to hospital-wide clinical workflows. They enhanced interdisciplinary coordination through increased dietitian engagement, the use of electronic health record alerts and new surgical protocols. These interventions lasted 8 months in 2016 and data reported here were collected from 985 patients before the interventions (2015) and 1046 patients after the interventions (2017). The study examines how these process changes affected LOS, infection rates and readmissions at TGH. Following implementation of these quality improvement processes, patients who were malnourished or at risk of malnutrition had a 25% reduction in LOS (from 8 to 6 days, p<0.01) and a 35.7% reduction in infection rates (from 14% to 9%, p<0.01). No statistically significant changes in readmission rates were observed. 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 policy-makers’ support for such programmes can spur more rapid uptake of nutrition-focused initiatives across care delivery settings. BMJ Publishing Group 2020-03-24 /pmc/articles/PMC7170540/ /pubmed/32213547 http://dx.doi.org/10.1136/bmjoq-2019-000735 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://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/.
spellingShingle Quality Improvement Report
Pratt, Kelsey Jones
Hernandez, Beverly
Blancato, Robert
Blankenship, Jeanne
Mitchell, Kristi
Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital
title Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital
title_full Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital
title_fullStr Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital
title_full_unstemmed Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital
title_short Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital
title_sort impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital
topic Quality Improvement Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170540/
https://www.ncbi.nlm.nih.gov/pubmed/32213547
http://dx.doi.org/10.1136/bmjoq-2019-000735
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