Assessment of the nutrition care process in US Hospitals using a web-based tool demonstrates the need for quality improvement in malnutrition diagnosis and discharge care

Abstract

Background: Malnutrition in hospitalized patients is a pervasive problem in the United States. To our knowledge, although malnutrition has been acknowledged as a concern for > 40 y, it has not yet been well addressed with a systematic, process improvement approach. Objectives: We aimed to characterize the current nutrition care process in US hospitals to establish a baseline for improvements. We also aimed to demonstrate the application of a web-based quality improvement tool as a simple approach to address malnutrition in hospitalized patients. Methods: We established a web-based tool to measure and assess nutrition care practices from hospital electronic medical records. Individual institutions self-selected to participate and were assigned a unique identifier to input data. Aggregated patient data from registered institutions were assessed. Data from all institutions were combined and are presented as the totals for each variable. Results: Of 243 registered users, 97 provided data and 150 reports were included in the analysis, resulting in a total of 107,106 patients. Almost all patients (89.98%) were screened for malnutrition risk within 24 h of admission, and ~30% were at risk for malnutrition. Of those at risk, ~65% received a registered dietitian nutritionist consultation or an order for an oral nutrition supplement. The rate of malnutrition diagnosis for those at risk was ~14%, and < 10% of patients received a recommendation or prescription for an oral nutrition supplement at discharge. Conclusions: Malnutrition remains an issue for hospitalized patients, particularly the gap between those screened as at risk and those diagnosed with malnutrition. Moreover, discharge recommendations for patients who are screened as at risk for malnutrition are also lacking. These data demonstrate that a web-based quality improvement tool could be used to capture the nutrition care practice at an institution level to provide directed approaches for addressing hospital malnutrition and improving care of patients at risk for malnutrition.