Preventing Hospitalization-Associated Disability

Problem: Hospital-associated disability (HAD) affects one-third of hospitalized adults, diminishing post-discharge independence and contributing to high mortality rates. Identifying at-risk patients through early assessment of nutritional and functional status upon admission is critical to personalizing care and improving discharge outcomes. Context: A 24-bed adult medical-surgical unit in a 173-bed suburban hospital in Northern California is part of a large not-for-profit healthcare organization. Interventions: Nursing staff received education on the Enhanced Recovery Medicine (ERM) pathway designed to prevent HAD. A visual display board, maintained and updated by unit champions, gave staff performance feedback. Nursing leadership reviewed admission assessments and addressed barriers daily. Measures: Outcome measures included the percentage of seven-day readmission rates and the percentage of patients discharged to home versus skilled nursing facilities. Process measures involved the percentage of completed admission Malnutrition Screening Tests (MST) and Previous Level of Function (PLOF) assessments. Results: By April 2024, MST completion rates had increased to 91%, and PLOF assessments had risen to 94%. During the intervention period, the percentage of patients discharged to home increased from 79% to 83%. Seven-day readmission rates remained unchanged. Conclusions: Completing nutritional and physical functional assessments upon admission allows customized care planning, enhances the patient's ability to maintain independence during hospitalization, and promotes discharge to home rather than skilled nursing facilities.