Completion of a Nutrition Assessment for Patients Identified as At-Risk for Malnutrition within 24 hours of a Malnutrition Screening

Patients identified as at-risk for malnutrition based on a malnutrition screening who have a nutrition assessment documented in the medical record within 24 hours of the most recent malnutrition screening.

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Patients who are malnourished while in the hospital have an increased risk of complications, readmissions, and length of stay, which is associated with a significant increase in costs. Malnutrition is also associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, and increased mortality. Referral rates for dietetic assessment and treatment of malnourished patients have proven to be suboptimal, thereby increasing the likelihood of developing such aforementioned complications. (Corkins, 2014), (Barker et al., 2011), (Amaral, et al., 2007), (Kruizenga et al. 2005). 

In a study of 409 patients with a median age of 68, researchers were able to demonstrate that declining nutritional status as assessed by the subjective global assessment (SGA), a validated assessment tool, was significantly associated with prolonged length of stay (Allard, 2016).

A study of 733 from more than a dozen hospitals identified that the completion of a validated assessment for patients who were hospitalized was able to detect predictors of outcomes for malnutrition such as length of stay and readmission within 30 days after discharge. (Jeejeebhoy, 2015).

"The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends the following:
1. Screening for nutrition risk is suggested for hospitalized patients (Evidence Grade E) 
2. Nutrition assessment is suggested for all patients who are identified to be at nutrition risk by nutrition screening (Evidence Grade E) 

The British Association for Parenteral and Enteral Nutrition recommends the maintenance of documentation for all individuals including results of nutritional screening and assessments, along with consequent action plans and treatment goals. If the patient is transferred to another care setting, this information should be readily available to all new carers to ensure continuity of care.

A consensus statement from the Academy of Nutrition and Dietetics states that theregistered dietitian's (RD) assessment of critically ill adults should include, but not be limited to the following: Food and Nutrition-Related History, Anthropometric Measurements,  Biochemical Data, Medical Tests and Procedures, Nutrition-Focused Physical Findings, Client History. Assessment of the above factors is needed to correctly diagnose nutrition problems and plan nutrition interventions. Inability to achieve optimal nutrient intake may contribute to poor outcomes."

Kaiser MJ, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010;58(9):1734-8.

Kruizenga HM et al., Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. AM J Clin Nutrition 2005 Nov 82(5): 1082-9.

Amaral TF, Matos LC, Tavares MM, Subtil A, Martins R, Nazaré M, et al. The economic impact of disease-related malnutrition at hospital admission. Clin Nutr. 2007 Dec;26(6):778–84. 

Corkins MR, Guenter P, DiMaria-Ghalili RA & Resnick HE. Malnutrition diagnoses in hospitalized patients: United States, 2010. JPEN J Parenter Enteral Nutr. 2014;38(2):186-95.

Sungurtekin H, Sungurtekin U, Oner O, Okke D. Nutrition assessment in critically ill patients. Nutr Clin Pract. 2008/2009;23:635-641.

Mueller C, Compher C & Druyan ME and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. A.S.P.E.N. Clinical Guidelines: Nutrition Screening, Assessment, and Intervention in Adults. J Parenter Enteral Nutr. 2011;35: 16-24.

British Association for Parenteral and Enteral Nutrition. Malnutrition Matters, A Toolkit for Clinical Commissioning Groups and providers in England. Published 2012. Retrieved from: http://www.bapen.org.uk/pdfs/bapen_pubs/bapen-toolkit-for-commissioners-and-providers.pdf. 

Academy of Nutrition & Dietetics. CI: Nutrition Assessment of Critically Ill Adults 2012. Academy of Nutrition & Dietetics Evidence Analysis Library. Published  2012. Retrieved from: http://www.andeal.org/topic.cfm?menu=4800.

Allard JP, Keller H, Jeejeebhoy KN, et al. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: A prospective cohort study. Clin Nutr. 2016;35(1):144-52.

Barker et al., Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System.  J Environ Res Public Health. Feb 2011; 8(2): 514–527. Published online Feb 16, 2011.  

Barker et al., Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System.  J Environ Res Public Health. Feb 2011; 8(2): 514–527. Published online Feb 16, 2011.  

Patients age 65 years and older at time of admission who are admitted to an inpatient hospital

Patients who were identified as at-risk for malnutrition upon completing a malnutrition screening

Patients with a length of stay of less than 24 hours

Patients in the denominator who have a nutrition assessment documented in the medical record within 24 hours of the most recent malnutrition screening.

For every patient evaluated by this measure also identify payer, race, ethnicity, and sex.