Feasibility and impact of a quality improvement initiative to screen for malnutrition in an Inflammatory Bowel Disease clinic

Abstract

Background and aims: Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract that is associated with malnutrition. Malnutrition is associated with poor clinical outcomes in patients with IBD and therefore early identification of those at risk for malnutrition is crucial. We aimed to evaluate how frequently nutrition screening occurs in a large, tertiary care outpatient IBD center and to initiate an intervention to improve malnutrition screening for patients with IBD.

Methods: We used a traditional plan-do-study-act quality improvement technique to understand our current malnutrition screening practices and institute an intervention to improve screening. To do this, we utilized a modified Malnutrition Universal Screening Tool (mMUST) and integrated this into the electronic health record. We then evaluated the intervention and the impact on IBD related clinical outcomes.

Results: Prior to the intervention, few patients with IBD were screened for malnutrition. However, the number of patients screened for malnutrition significantly improved with the study intervention and those who were identified as high-risk had increased nutrition follow up including serum micronutrient evaluations and referral to a dedicated registered dietician.

Conclusion: This study demonstrated the feasibility and impact of a malnutrition screening program in ambulatory IBD patients. Those patients identified as high risk for malnutrition who engaged in nutrition care had improved clinical outcomes including reduced hospitalizations and emergency room visits.

Keywords: Crohn's disease; Inflammatory bowel disease; Malnutrition; Screening; Ulcerative colitis.