Director, Nutrition Services Children's Mercy Kansas City Overland Park, Kansas
understand at least one way to identify pediatric malnutrition in the outpatient setting.
The significance of pediatric malnutrition is well-known. Patients meeting criteria for malnutrition, including severe malnutrition, are not always identified in outpatient clinics. Our goal was to improve identification of patients meeting criteria for severe pediatric malnutrition (based on BMI z score) and to provide appropriate intervention when possible. Identifying patients with malnutrition in the outpatient setting has potential to possibly prevent an inpatient stay.In 2018, a multidisciplinary team sought an opportunity to identify patients meeting severe malnutrition criteria targeting as many outpatient clinics as possible. A weekly report was created to prospectively identify patients by name, BMI z score, date, time, and location of clinic appointment. The report also indicated the date of any previous nutrition documentation within the last 6 months which served as the intervention. Four clinics were also monitored to determine the volume of severely malnourished patients. Intervention for those patients identified as severely malnourished, but without access to a Dietitian in clinic, was email communication to the primary care provider stating the patient risk for malnutrition and requesting a referral to Nutrition Clinic. The report was run weekly for 100 weeks (July 2018-May 2020). An average of 97 patients per week were identified as meeting criteria for severe malnutrition. 36% of those identified had not had nutrition intervention documented within the last 6 months. Of the 36%, 23 of those patients (64%) without nutrition intervention were attending appointments in clinics not staffed by a Dietitian and thus did not have access to a Dietitian in clinic.