Implementation of an electronic solution to improve malnutrition identification and support clinical best practice

Abstract

Background Routine malnutrition risk screening of patients is critical for optimal care and comprises part of the National Australian Hospital Standards. Identification of malnutrition also ensures reimbursement for hospitals to adequately treat these high‐risk patients. However, timely, accurate screening, assessment and coding of malnutrition remains suboptimal. The present study aimed to investigate manual and digital interventions to overcome barriers to malnutrition identification for improvements in the hospital setting. Methods Retrospective reporting on malnutrition identification processes was conducted through two stages: (1) manual auditing intervention and (2) development of a digital solution – the electronic malnutrition management solution (eMS). Repeated process audits were completed at approximately 6‐monthly intervals through both stages between 2016 and 2019 and the results were analysed. In Stage 2, time investment and staff adoption of the digital solution were measured. Results Overall, the combined effect of both regular auditing and use of the eMS resulted in statistically significant improvements across all six key measures: patients identified (97%–100%; p < 0.001), screened (68%–95%; p < 0.001), screened within 24 h (51%–89%; p < 0.001), assessed (72%–95%; p < 0.001), assessed within 24 h (66%–93%; p < 0.001) and coded (81%–100%; p = 0.017). The eMS demonstrated a reduction in screening time by over 60% with user adoption 100%. Data analytics enabled automated, real‐time auditing with a 95% reduction in time taken to audit. Conclusions A single digital solution for management of malnutrition and automation of auditing demonstrated significant improvements where manual or combinations of manual and electronic systems continue to fall short.

Using an interactive nutrition technology platform to predict malnutrition risk

“…[27][28][29] Identifying and managing malnutrition is a time sensitive issue, with missed or delayed referrals to a dietitian resulting in poorer health outcomes. 11,24 A multi-disciplinary approach is important for optimal identification and management of malnutrition. Research indicates that screening and referral of patients at risk of malnutrition is not adequate in many hospitals.…”

“…11 Research pertaining to the use of technology in the identification of malnutrition in hospitals is limited; however, preliminary studies indicate that the use of technology (including intake self-monitoring applications, electronic medical records and computerised malnutrition assessments) can assist in the identification and management of malnutrition. 11,16,17 Evidence surrounding nutrition intake monitoring tool technology (such as the Nutrition Dashboard) is particularly limited because of the need for hospital expenditure and infrastructure to implement them. 16 The present study aimed to establish the accuracy of the Nutrition Dashboard in identifying clients with low dietary intakes (and therefore likely to be at risk or experiencing malnutrition) and to compare this to assessment with MST scores.…”

“…The Nutrition Dashboard provides insights into nutritional intake, which may relate to nutritional status 9,11 (see Supporting information, Supplementary file S2, Figures S2 and S3). Traditionally, food intake is assessed in hospitals using patient recall or food intake records completed by healthcare staff.…”

“…There is increasing research regarding innovative technologies to assess food intake. Recent research indicates that novel diet assessment technologies, including the technology used to collect data which populates the Nutrition Dashboard can be valid at the individual level 11 . Research pertaining to the use of technology in the identification of malnutrition in hospitals is limited; however, preliminary studies indicate that the use of technology (including intake self‐monitoring applications, electronic medical records and computerised malnutrition assessments) can assist in the identification and management of malnutrition 11,16,17 .…”

“…Recent research indicates that novel diet assessment technologies, including the technology used to collect data which populates the Nutrition Dashboard can be valid at the individual level 11 . Research pertaining to the use of technology in the identification of malnutrition in hospitals is limited; however, preliminary studies indicate that the use of technology (including intake self‐monitoring applications, electronic medical records and computerised malnutrition assessments) can assist in the identification and management of malnutrition 11,16,17 . Evidence surrounding nutrition intake monitoring tool technology (such as the Nutrition Dashboard) is particularly limited because of the need for hospital expenditure and infrastructure to implement them 16 …”