Posted: September 14, 2023
The Malnutrition Workgroup Committee was formed in 2015. It is a multi-disciplinary team made up of Physicians, Advanced Practice Providers, Registered Dietitians, Clinical Documentation Integrity Analysts, Accreditation Specialists, Coding Quality Specialists, Registered Nurses, Clinical Performance Improvement and Quality Management, Revenue Cycle and more. Among many of the committee’s initiatives over the last 8 years, the most recent has been the malnutrition pilot program which established our 2 inpatient Malnutrition Specialist Registered Dietitians (RDs). These RDs operate using an altered workflow and lower RD to patient ratio. We are assessing how this changes our ability to identify and intervene on malnutrition sooner to improve our patient’s outcomes.
Our Malnutrition Specialist RDs
Lizzy Schnicke, RD, LD, CNSC, is an inpatient dietitian primarily covering general medicine. She is originally from Cincinnati, OH and graduated from The University of Alabama. She completed her post-grad internship with The Ohio State University Human Nutrition Dietetic Internship. Lizzy is recently board-certified nutrition support clinician. Lizzy has worked as an inpatient clinical RD and outpatient oncology RD. She transitioned her career in May of 2022 to OSUWMC to join the malnutrition pilot program as a malnutrition specialist.
Sarah Holland, MSc, RD, LD, CNSC, has been with the inpatient clinical nutrition team for a little over 2 years. She is originally from Ontario, Canada with her academic and dietetic training completed at the University of Guelph and University of Alberta. She has been working as a Clinical Dietitian for over 15 years and has been a board-certified-Nutrition Support Clinician for 12 years.
Left to right: Cassie Fackler, Amy Patton, Sarah Holland, Lizzy Schnicke (Malnutrition Workgroup members) at the Allied Health Innovation Conference.
Q+A with members of the Malnutrition Workgroup Committee
Natalie Stephens is a Registered Dietitian, formerly within the Nutrition Services department, and currently works as an Assistant Director with Hospital Accreditation.
Dr. Manoj Ramachandran is a Physician with the Division of Hospital Medicine, Clinical Assistant Professor of Internal Medicine, and our committee’s physician champion.
Shawn Turner is a Registered Nurse who works as Clinical Documentation Improvement Analyst for The James.
When and why did you get involved in the hospital’s malnutrition initiatives?
- NS: I was part of the inaugural launch of the malnutrition workgroup when I was a Lead Dietitian.
- MR: My involvement with the hospital malnutrition initiative started with an email I sent to Emily Lisciandro (she was the Assistant Director of Nutrition at that time) on November 4, 2015. This was followed by a few exchanges, and we had the first meeting on November 23, 2015. Participants of the first meeting were Emily Lisciandro, Shawn Turner, Rebecca Wehner, Brett Payne, and myself.
- ST: I started on this committee since inception. I see the impact nutrition has on our patient population. The initiatives are valuable in recognizing malnutrition, involving the Service Care Teams and developing successful nutrition goals for the patients.
What is your role in the committee and the initiatives?
- NS: I provide ongoing support to the committee through my position in Accreditation through the lens of an RDN.
- MR: For a long time, I was the only physician in the workgroup. I consider myself the physician lead for the workgroup.
- ST: I am a representative for James Clinical Documentation Integrity Team.
How you see the impact malnutrition has on our patients and their outcomes?
- NS: Our Mission says it all. It’s our promise to make a difference to people. By screening for malnutrition, we’re leveraging an evidence-based tool which is recommended by regulatory bodies including CMS and Joint Commission. The subsequent assessment from our clinical nutrition team meets patient individuality standards through provision of care and patient rights. When physicians document the diagnosis based on the current standards, we have the ability to identify and provide resources to care for this challenging population. Finally, by connecting patients to resources at discharge, we’re completing the circle of care and truly helping improve quality and safety while hopefully preventing future hospitalization because we’re helping to heal our patients from start to finish. If we can tackle malnutrition as soon as it’s identified, we can reduce morbidity and mortality, infection risks, length of stay and readmissions.
- MR: I see the impact of appropriate screening and diagnosis of malnutrition early in the hospital stay as huge in getting a head start when it comes to initiatives to reduce the LOS, re-admission, decrease the number of falls, decrease the complications, and more. Risk adjustment involves comparing the outcomes with the expected outcome. Malnutrition often has a dual impact on both sides of the equation in many of the metrics due to risk adjustment.
- ST: Malnutrition is a serious barrier to our patients recovering timely from any health crisis or surgery. In turn, this lead to longer length of hospital stays, increased healthcare costs and ultimately impacting the patient’s overall health (mental and physical).
What steps do you feel we should take to help our patients with malnutrition and to prevent malnutrition occurrence?
- NS: By getting out into the community to educate on malnutrition and its connection to social determinants of health, geriatric standards of care (it’s not normal to lose muscle as you age), the impact of lean mass on falls prevention and frailty, etc. We will help our community members live longer, higher quality lives by preventing malnutrition, but we need to get out there, so they understand what is happening, and know how to implement change to be successful.
- MR: IF dietitians can see the patients earlier during the inpatient stay, that would help with the recognition of more cases. I also feel we should have better collaboration across different clinicians who do similar screenings. For example, physical therapists and occupational therapists complete a functional assessment. If they record the hand grip strength, this can complement the Nutrition Focused Physical Exam (NFPE) completed by the dietitian.
- ST: In an ideal world with ample staffing, ongoing follow up with nutrition goals post-discharge which could be in the form of phone calls. Also, discuss using an app they would elect to log in and track. Example, after my mom’s hip surgery, she has a care team member who calls her every Monday to discuss her prior week diet and exercise. She was provided a scale that is synced with an app, so it tracks how she’s doing.