Q: What encouraged TIRR Memorial Hermann to join
the MQii Learning Collaborative?
A: TIRR recognized that to date,
limited data and research exist that describe the
prevalence of malnutrition and the impact on
outcomes in inpatient rehabilitation using updated
malnutrition diagnostic criteria (American Society for
Parenteral and Enteral Nutrition/Academy of Nutrition
and Dietetics). TIRR is proud to be the
first Acute Inpatient Rehabilitation Hospital
to join the MQii Learning Collaborative, which
aligns with our commitment to advocacy for our patients'
health outcomes across all spectrums of care.
Q: What stage of the malnutrition clinical
workflow is TIRR Memorial Hermann choosing to focus
on? What are your malnutrition quality improvement
goals for 2018?
A: In 2017, we focused on
continuous nutrition risk monitoring. Upon
evaluation of areas of improvement, using
MQii's Malnutrition Workflow Map, we identified
continuous nutrition risk monitoring as
a foundational piece to implementing best
practice, as our average length of stay is
approximately 30 days.
In 2018, we are focusing on Nutrition Care Planning
for our most at-risk patients. With the
highest case-mix index in the nation, we are developing
novel strategies in the rehabilitation setting to care
for medically complex patients. Once
these strategies have demonstrated measurable
improvement toward best practice, we will begin
intentional implementation across the large TIRR Rehab
Network, which includes seven Inpatient Rehab Units, and
seven Complex Outpatient Neuro Centers.
Q: What sort of impact has participation in the
MQii Learning Collaborative had on your
facility?
A: With the unwavering support of
TIRR and MQii leadership, we have strengthened
interdisciplinary alliances as well as created task
forces and committees at campus and system levels to
realize the prevention and treatment of
malnutrition.
Q: What was the biggest surprise to TIRR Memorial
Hermann when you undertook your quality initiative
project?
A: In the short-term, this
project validated TIRR leadership opinions and realized
that our clinicians, due primarily to their workflow,
may not have had disseminated pertinent clinical
information to the entire care team in a timely manner.
This was recognized as an opportunity to centralize and
streamline communications surrounding nutrition risk
monitoring.
In retrospect, I think the rapid success of best practice
implementation was somewhat of a surprise. With the
great support and collaboration of TIRR leadership, less
than 6 months after launching our first QI initiative,
we are positioning to expand our implementation
system-wide across the TIRR Rehab Network.
Q: Can you share one or two lessons learned from
TIRR Memorial Hermann participation in the MQii
Learning Collaborative so far?
A: Undoubtedly, our participation
with MQii has elevated and expanded our impact on
malnutrition care. The multifaceted collaboration
involved along the continuum of implementation necessary
for individual campus success cannot be
understated. Though we initially started with a few
key players, now eight months later, every single leader
at TIRR played a role in the success of this endeavor.
Thank you, Rya, for sharing your approach to
addressing continuous risk monitoring for
malnourished patients to reduce patient length of
stay. Please let your MQii Team Point of Contact
know if you have any questions for Rya or if you have a
best practice you would like to share with the other
Learning Collaborative participants.
