Abstract：
BACKGROUND: Nutrition monitoring is essential in feeding tube-dependent patients receiving home enteral nutrition (HEN). We identified lack of consistency in dietitian evaluations for our pediatric patients receiving HEN. Consequently, after establishing an institutional standard for nutrition reassessment intervals, we underwent a quality improvement (QI) initiative to improve rates of adherence to standard frequency of dietitian consults and referrals among patients receiving HEN.
METHODS: A prospective QI initiative from April 2021 to December 2021 was performed using multiple plan-do-study-act (PDSA) cycles. Interventions included (1) a reminder placard, (2) the display of feeding tube status and date of the last dietitian note in the electronic health record (EHR) clinic schedule dashboard, and (3) an autotext smart element to the EHR default clinic note template. The goal was to enable clinicians to quickly identify the need for nutrition evaluation with either a same-day dietitian consult or a referral to nutrition clinic.
RESULTS: Among 111 HEN patients with >6 months since last nutrition encounter, the dietitian referral/consult rate prior to any interventions was 58%. The placard (PDSA 1) was abandoned before obtaining reportable data because of sampling bias and clinic workflow inefficiencies. The clinic schedule dashboard modification (PDSA 2) improved the dietitian referral/consult rate to 66%. Subsequently, the clinic note smart element (PDSA 3) increased the rate to 77%. An 8-week postintervention check revealed a compliance rate of 78%.
CONCLUSIONS: Implementation of minimally interruptive EHR enhancements showed a sustained increase in dietitian referrals and consults for patients receiving HEN, which may improve nutrition outcomes.
METHODS: A prospective QI initiative from April 2021 to December 2021 was performed using multiple plan-do-study-act (PDSA) cycles. Interventions included (1) a reminder placard, (2) the display of feeding tube status and date of the last dietitian note in the electronic health record (EHR) clinic schedule dashboard, and (3) an autotext smart element to the EHR default clinic note template. The goal was to enable clinicians to quickly identify the need for nutrition evaluation with either a same-day dietitian consult or a referral to nutrition clinic.
RESULTS: Among 111 HEN patients with >6 months since last nutrition encounter, the dietitian referral/consult rate prior to any interventions was 58%. The placard (PDSA 1) was abandoned before obtaining reportable data because of sampling bias and clinic workflow inefficiencies. The clinic schedule dashboard modification (PDSA 2) improved the dietitian referral/consult rate to 66%. Subsequently, the clinic note smart element (PDSA 3) increased the rate to 77%. An 8-week postintervention check revealed a compliance rate of 78%.
CONCLUSIONS: Implementation of minimally interruptive EHR enhancements showed a sustained increase in dietitian referrals and consults for patients receiving HEN, which may improve nutrition outcomes.
摘要：
背景：营养监测对于接受家庭肠内营养（HEN）的饲管依赖患者至关重要。我们发现在接受HEN的儿科患者的营养师评估中缺乏一致性。因此,在建立了营养重新评估间隔的机构标准后，我们实施了一项质量改进(QI)计划,以提高接受HEN的患者对标准营养师咨询和转诊频率的依从性.
方法：2021年4月至2021年12月的前瞻性QI计划采用多个计划-做-研究-行为（PDSA）周期进行。干预措施包括（1）提醒标牌，（2）在电子健康记录（EHR）诊所时间表仪表板中显示喂食管状态和上次营养师注释的日期，和（3）EHR默认临床笔记模板的自动文本智能元素。目标是使临床医生能够通过当天的营养师咨询或转诊到营养诊所来快速确定营养评估的需求。
结果：在111名自上次营养治疗以来超过6个月的HEN患者中，任何干预措施前的营养师转诊/咨询率为58%.由于采样偏差和临床工作流程效率低下，在获得可报告数据之前放弃了标语牌（PDSA1）。诊所时间表仪表板修改（PDSA2）将营养师转诊/咨询率提高到66％。随后，临床注意到智能元件(PDSA3)的比率提高到77%。一项为期8周的干预后检查显示，依从率为78%。
结论：实施最小中断性EHR增强措施显示，接受HEN的患者的营养师转诊和咨询持续增加，这可能会改善营养结果。
方法：2021年4月至2021年12月的前瞻性QI计划采用多个计划-做-研究-行为（PDSA）周期进行。干预措施包括（1）提醒标牌，（2）在电子健康记录（EHR）诊所时间表仪表板中显示喂食管状态和上次营养师注释的日期，和（3）EHR默认临床笔记模板的自动文本智能元素。目标是使临床医生能够通过当天的营养师咨询或转诊到营养诊所来快速确定营养评估的需求。
结果：在111名自上次营养治疗以来超过6个月的HEN患者中，任何干预措施前的营养师转诊/咨询率为58%.由于采样偏差和临床工作流程效率低下，在获得可报告数据之前放弃了标语牌（PDSA1）。诊所时间表仪表板修改（PDSA2）将营养师转诊/咨询率提高到66％。随后，临床注意到智能元件(PDSA3)的比率提高到77%。一项为期8周的干预后检查显示，依从率为78%。
结论：实施最小中断性EHR增强措施显示，接受HEN的患者的营养师转诊和咨询持续增加，这可能会改善营养结果。
