By Jessica Marchand, RD, LDN, and Roseann Hoeye, MBA, RD, LD; Directors, Intalere Nutrition & Environmental Services
In 1974, the article “Skeleton in the Hospital Closet,” by the late Charles E. Butterworth, Jr., M.D., called attention to the existence of malnutrition in our nation’s hospitals. While it’s been more than 40 years since this article was published, hospital malnutrition still remains a serious issue today.
The burden of malnutrition in hospitalized adults is a leading cause of morbidity and mortality, especially among older adults. In 2013, the Academy of Nutrition and Dietetics (AND) joined with Avalere, a research and advisory services firm dedicated to solving issues facing our healthcare system, with the mission to highlight the gaps in existing malnutrition care and the impact on patient outcomes. Hence, the Malnutrition Quality Improvement Initiative (MQii) was born.
The objective of the MQii is to improve the effectiveness and timeliness of malnutrition care through the use of an evidence-based toolkit by all members of a facility’s interdisciplinary team. It also puts greater focus on malnutrition screening and intervention through regulatory and/or legislative changes across the nation’s healthcare system.
According to the MQii, evidence suggests that 20-50% of all patients are at risk or malnourished at the time of hospital admission. Typically diagnosed in only 7% of hospitalized patients, the actual number undiagnosed could be staggering. Moreover, patients who are malnourished during their stay have a substantially greater risk of complications, falls, pressure ulcers, infections, readmissions and longer length of stay, which is associated with increases in healthcare costs up to 300%.
Today, Registered Dietitian Nutritionists (RDNs) continue to focus on improving the speed and accuracy of diagnosing malnutrition and refining nutrition interventions in all healthcare settings. While considerable attention is directed in the hospital setting, malnutrition has been widely established to occur in the non-acute setting as well. Specifically, in long-term care, rehabilitation and behavioral health facilities, to name a few.
In order to address malnutrition in the non-acute setting, the Association of Nutrition and Foodservice Professionals (ANFP) published an article in February 2016 that addresses the importance of using validated screening tools and timely referrals by appropriate healthcare providers when malnutrition is suspected. The roles of the Certified Dietary Manager (CDM) and the RDN are key in assessing malnutrition, providing medical nutrition therapy, ensuring food preferences are honored and designing enticing menus.
In summary, RDNs and CDMs have the opportunity to not only increase awareness of malnutrition, but to also improve patient outcomes by working collaboratively with providers in an interdisciplinary healthcare team to administer the best nutrition interventions. With a shared goal to address the patients’ nutritional needs and improve outcomes in a time of national healthcare reform, they can help to properly identify, document and advocate for patients who enter the healthcare continuum with malnutrition or who develop it during their stay.
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