Horizon initiative sparks national change in malnutrition coding, leading to improved patient outcomes

By allowing registered dietitians to code for malnutrition, there is less risk of cases going unreported or untreated, leading to more accurate reporting and better care

What started as an internal initiative led by Horizon’s Clinical Nutrition team has led to a national change and is impacting how malnutrition is flagged and coded in hospitals across Canada.

On April 1, the Canadian Institute for Health Information (CIHI) implemented a new national coding direction requiring the assignment of a diagnosis code for malnutrition when it is documented by a registered dietitian in a patient’s health record. Previously, a malnutrition diagnosis code could be assigned only when a physician documented it.

Malnutrition is a common condition, with an estimated 40 to 50 per cent of hospitalized patients across Canada being malnourished. It significantly impacts not only a patient’s health, but also their care and treatment, making early identification and intervention essential for improved patient outcomes.

“Malnutrition isn’t simply an issue with nutrition or a consequence of illness,” said Jill Thibodeau, Horizon’s Clinical Nutrition Manager for the Moncton area. “Malnutrition is a clinical condition that impacts patient outcomes and increases their length of stay. A malnourished surgical patient, for example, may face delays due to their wounds healing more slowly and is at a higher risk of developing an infection.”

How it started

Horizon screens all patients upon admission for malnutrition and automatically refers those deemed at risk to be seen by a registered dietitian. In 2022, the Clinical Nutrition team created a system to flag patients who needed to be coded for malnutrition by physicians when inputting information into a patient’s chart.

A green sticker identifying the dietitian’s nutrition diagnosis of malnutrition was placed in the physicians’ orders to prompt documentation of the diagnosis, allowing it to be coded by the CIHI. This ensured better data on malnutrition rates was captured and sparked a national change in how the data is captured and recorded.

How it sparked a national change

After seeing success with the green stickers at Horizon, the Clinical Nutrition team took it to the Canadian Malnutrition Task Force (CMTF) to hopefully encourage other hospitals across Canada to implement similar approaches.

While many other hospitals and organizations did adopt the process, the CMTF took things a step further and submitted a proposal to the CIHI advocating for malnutrition diagnoses documented by Registered Dietitians to be accepted for coding purposes.

“Dietitians are often the professionals who identify and document malnutrition as a diagnosis in the patient’s medical record,” said Thibodeau. “But historically, that data wasn’t being accurately captured because physicians also needed to document it. By removing the need for that second documentation, it not only ensures better capture and reporting of the number of cases of malnourished patients we’re seeing in our hospitals, but also recognizes and reinforces the essential role registered dietitians have in health care.”

By accurately capturing the prevalence of malnutrition in hospitals across Canada, the CMTF and CIHI can better focus future studies and research, ultimately leading to better treatments and care.

At Horizon, the proper diagnosis is already helping improve patient care.

“By properly identifying malnutrition when patients are admitted, our dietitians can work with the patient’s care team throughout their stay,” said Connie Coffin, interim Director of Therapeutic Services for the Saint John area. “A dietitian can monitor and provide ongoing assessments and ensure their nutritional needs are being met while they’re receiving care. This helps reduce the risk of patients developing complications or delays in their discharges and contributes to better overall care.”