Using Quality Improvement to Improve Identification and Documentation of Malnutrition in Hospitalized Pediatric Patients

Abstract

Introduction: Recent publications have highlighted the importance and impact of recognizing malnutrition in hospitalized children. After noting that patients with malnutrition frequently went unrecognized in our facility, we implemented an interprofessional intervention comprising hospital medicine physicians, dietitians, and the clinical documentation improvement team to improve recognition and documentation of malnutrition in these patients, thereby facilitating earlier intervention. Methods: We implemented three separate plan-do-study-act cycles to improve the identification and documentation of malnutrition among patients hospitalized at our facility. The cycles consisted of identifying malnutrition using z-scores, educating providers, and implementing smart text within the medical record to help with consistent documentation. In addition, real-time communication between the disciplines (nutrition services, clinical documentation improvement providers, and hospitalists) was also employed to improve documentation quality. After completing the plan-do-study-act cycles, charts were reviewed to evaluate the nutritional interventions received. Results: Baseline data revealed that only 13% of patients with z-scores indicative of malnutrition were identified as such in attending physicians' documentation. Upon implementation of our plan-do-study-act cycles, documentation of these patients increased to greater than 64%. Patients with documented malnutrition received nutritional interventions at least 81% of the time, increasing from 35% at baseline. Conclusion: Our findings demonstrate that an interprofessional approach can dramatically enhance the identification and documentation of malnutrition in hospitalized children, leading to earlier intervention.