UTILIZING NUTRITION RISK SCREENING TO TACKLE 30-DAY UNPLANNED READMISSIONS AND LENGTH OF STAY AMONG HOSPITALIZED ADULT PATIENTS

Purpose: While the need to utilize validated nutrition screening tools to inform necessary interventions for hospitalized patients is widely accepted, their incorporation in electronic medical records (EMR) has been only recently studied. We conducted a quality improvement program (QIP), where EMR was upgraded to include a validated standardized tool, Malnutrition Screening Tool (MST), and condition-specific ONS was administered to all patients at risk for malnutrition (MST ≥ 2). We aimed to compare the readmission rates and hospital length of stay (LOS) between patients with MST scores of 2 and >2 to determine differences regarding their risk for 30-day readmissions and prolonged hospitalizations.

Methods: Data from 1269 patients enrolled in the QIP between October 2014 and April 2015 were analyzed and were grouped into MST = 2 and MST > 2. 413 (32.5%) patients had an MST of 2, while 856 (67.5%) patients had MST > 2. Patients in each MST group were further stratified by age: <65 versus ≥ 65 years old. All patients were screened for malnutrition during their stay at one of the four participating QIP hospitals, where electronic medical record (EMR) was upgraded to include Malnutrition Screening Tool (MST) and condition-specific ONS was administered to patients with MST score ≥ 2.

Results: Unplanned 30-day readmission rate for patients with MST of 2 was 14%, while the readmission rate of patients with MST > 2 was 17.1% (P=0.171). Average LOS was 5.19 (± 4.78) days and 4.49 (± 4.69) days, respectively (P=0.277). When stratified by age, the differences for readmission rates and LOS within the age subgroups and between the MST groups were statistically non-significant (P>0.05). 

Conclusions: Patients with MST scores of 2 and > 2 are equally likely to be readmitted and experience longer hospitalizations; thus highlighting the importance of EMR implementation and utilization of a validated screening tool like MST to assess nutritional status at admission. Accurate MST assessment could prevent patients from experiencing further declines in their nutrition status during their inpatient stay. Comprehensive nutrition focused interventions could have a significant impact on reducing 30-day unplanned readmissions and LOS amongst malnourished hospitalized patients regardless of age.