289 Background: Patients with GI cancer have amongst the highest rates of malnutrition, which contributes to decreased quality of life, increased morbidity and mortality, as well as higher healthcare costs. In the GI Oncology clinic at Parkland Health and Hospital System (PHHS), the number of patients with a documented nutritional plan by a registered dietitian was 7%, and there was no standardized screening method for malnutrition in place. Methods: The aim was to increase the rate of documented nutritional assessment by a registered dietitian to 25%. Multidisciplinary sessions involving physicians, registered dietitians, registered nurses, and hospital administration were arranged to identify barriers to nutritional interventions for GI Oncology clinic patients. Results: Prior to QI interventions, between October-December 2018, the total number of GI cancer patients referred to registered dietitian clinic was 11- 30 referrals, which accounted for 7-10.1% of GI cancer patient in the respective month. As part of first PDSA cycle, a registered-dietitian was assigned to GI oncology clinic. The total number of documented nutrition plan after first intervention was 22 GI cancer patient (15% of GI cancer patients). We then developed an adapted-version of the Malnutrition Screening Tool (MST) and implemented it through the institute electronic medical record. The nursing staff and physicians were educated about administering the screening tool and the referral process to a registered-dietitian after a positive MST screen. After the first month during which MST was implemented, the rate of nutritional assessment increased to total of 20.5% of GI cancer patients (total 37 referrals). Twenty out of the 37 referrals (54%) were due to the positive MST screening tool. Conclusions: Through a nutrition focused QI program, we doubled the rate of a documented nutritional plan for PHHS GI cancer patients in a month of starting the 2nd PDSA cycle intervention. Through future PDSA cycles, we plan to further increase patient access to nutritional assessments and then broaden our efforts to the entire PHHS oncology clinic.

e19163 Background: Patients with GI cancer have high rates of malnutrition related poor outcomes. In the GI Oncology clinic at Parkland Health and Hospital System (PHHS), a safety net hospital, the number of GI cancer patients with a documented nutrition assessment by a registered dietitian was 5-7%. The aim of QI project was to increase the rate of documented nutrition assessment by a registered dietitian to 25%. Methods: Three PDSA cycles were conducted after identifying barriers to nutritional interventions. A registered dietitian was assigned to the GI oncology clinic during the 1st PDSA cycle, an adapted Malnutrition Screening Tool (MST) was implemented through the institute electronic medical record during 2nd PDSA cycle, and clinical staff was trained during 3rd PDSA cycle. Patient weight, ECOG performance status, and serum albumin were recorded at initial visit and 3-month follow up from May-July 2019. Paired t Test was performed. Results: Through PDSA cycles, the percentage of GI oncology patients with documented nutrition assessment increased from 5.9% to 21.8% by July 2019 and has sustained over subsequent 6-month period. From May-July 2019, there were 132 new patients seen by the registered dietitian, with 63/132 patients (47.7%) with GI cancer. Between the initial dietitian visit and 3-month follow up, significant average difference in weight -1.14 kg (CI: -2.17, - 0.19; p 0.02) was observed among all patients. However, there was no significant difference observed in average difference in weight in GI cancer patients -0.78 kg (CI: -2.4, +0.9; p = 0.34). Improvement and stability in ECOG performance status was observed in 87.5% of GI cancer patients and there was a non-significant improvement in average difference in serum albumin. Conclusions: Through a nutrition focused QI program on GI cancer patients at high risk of malnutrition, the rate of documented nutrition assessment was doubled. The GI cancer patients maintained weight, ECOG performance status, and serum albumin over 3-months.

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