Within the workbench, screening for nutritional status is automated.  This indicates if and when a patient is at high, moderate or low risk for nutritional concerns.  As status changes throughout the stay, screening continues through the system and indication of a risk change will automatically alert the dietitian.  This triggers a faster assessment order, faster assessment completion and a faster implementaiton of intervention to show improved patient status.

While automated screening triggers an increase in assessment completion, assessment completion triggers an increase in intervention at a much faster rate.  The automated processes within the system allow dietitians with order writing privledges the capability to order an intervention through the Clinical Nutrition Workbench even within their assessment tool.  Dietitians without order writing privledges still benefit from the program's automation; as assessments are completed, direct messages can be sent to the attending MD & NP to ensure improved communication of the nutrition intervention recommendation.  The system guarantees improved carry out of nutrition intervention.  Getting patients better, faster & reducing the length of stay needed for recovery.

RECOMMENDATIONS
Experts recommend a number of measures to ensure effective nutrition care in hospitals26: (1) develop an institutional culture of good nutrition care that extends to all stakeholders; (2) clarify and define roles for each clinician; (3) use routine screening to identify the patient's nutrition risk, with a screening tool that has been validated, is easy to implement, and simple to use; (4) start nutrition intervention promptly for patients at risk for malnutrition; (5) prepare and implement individualized nutrition plans; (6) monitor patients' nutrition status throughout their hospital stay; and (7) create a post-discharge nutrition plan. 

SUMMARY
In summary, our results in this retrospective cohort study show that implementation of a nutrition-focused QI initiative in hospitalized patients shortened the time to diagnosis and treatment of malnutrition and significantly reduced hospital LOS. We also showed how including nurses in nutrition screening and ONS prescription could accelerate the delivery of nutrition care. Furthermore, the savings on reduced LOS in this study can be estimated to far exceed the cost of treatment with ONS. Thus, interventions focused on improving nutrition in hospitalized patients represent a low-risk, cost-effective strategy to improve the quality of hospital care. These results provide a rationale for building on the strengths of the QI initiative used in our study and expanding this approach to additional hospitals.

REFERENCES

1. Singh H, Watt K, Veitch R, Cantor M, Duerksen DR. Malnutrition is prevalent in hospitalized medical patients: are housestaff identifying the malnourished patient? Nutrition. 2006;22(4):350–354.

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