OBJECTIVES: With over half of hospitalized patients at risk for malnutrition, nutrition-focused quality improvement (QI) initiatives were implemented to determine if early malnutrition risk identification and initiation of nutrition therapy impacted length of stay, readmission rates, and diagnosis of malnutrition.

METHODS: The QI was fully implemented in February 2016 in three hospitals of KentuckyOne Health, a market based organization of Catholic Heath Initiatives. Nursing screened patients on admission using the Malnutrition Screening Tool (MST) and initiated oral nutritional supplements (ONS) for patients at risk for malnutrition as identified by MST score. Additionally, the Sodexo Comprehensive Malnutrition Platform was implemented by dietitians to help determine type and severity of malnutrition for improvement of clinical outcomes. Retrospective electronic medical records for 20,697 adult patients (age ≥ 18) admitted between September 2014 and February 2015 (historical group) were compared with those admitted between September 2016 and February 2017 (post-QI Initiative). Treatment patients at risk of malnutrition were those who had an MST score ≥ 2 or received an ONS or had one of the malnutrition ICD-9 or ICD-10 codes documented during their hospital stay. All other patients were placed in the control group. A difference-in-difference methodology was used to assess the impact of the QI initiatives.

RESULTS: The median time from patient hospital admission and MST to ONS initiation was reduced by 14.9% and 39.3% respectively (both p <0.01). Decreases in LOS and readmission rates were 0.88 days (p<0.05) and 0.18% (p>0.1) greater for the malnourished group compared to the non-malnourished group. The patients diagnosed with malnutrition increased from 3.14% to 6.84% (p<0.01).

CONCLUSIONS: Both health and nutrition process outcomes among malnourished hospitalized patients can be significantly improved through nutrition-focused QI intervention. These results highlight the importance of adequate nutrition screening, education, and treatment of all hospitalized patients, particularly those identified with malnutrition.