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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Improving anthropometric measurements in hospitalized children: A quality-improvement project
Sabrina Persaud1,2, Bridget M Hron2,3, Coral Rudie2
1Clinical Education, Informatics, Quality and Professional Practice Department, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
This quality improvement project successfully boosted pediatric anthropometric documentation rates, significantly increasing the identification of malnutrition risk. The intervention involved multidisciplinary teams and led to substantial improvements across hospital units.
Area of Science:
- Quality Improvement in Healthcare
- Pediatric Patient Safety
- Nutritional Assessment
Background:
- Accurate anthropometric measurements (weight, height, BMI) are crucial for identifying pediatric patients at risk of malnutrition.
- Pre-intervention documentation rates for these critical metrics were below 50% within 24 hours of hospital admission.
Purpose of the Study:
- To implement a quality improvement initiative to increase anthropometric documentation rates.
- Targeted an 80% documentation rate within 24 hours for pediatric hospital admissions.
Main Methods:
- Established multidisciplinary champion teams on surgical, cardiac, and ICU pilot units.
- Iteratively tested interventions to address documentation barriers from May 2016 to June 2018.
- Utilized statistical process control for monthly assessment and chi-squared tests for pre/post intervention comparison.
Main Results:
- Significant increases in anthropometric documentation rates were observed across all pilot units (e.g., BMI from 11% to 89% in surgical).
- Hospital-wide BMI documentation improved from 42% to 70%.
- Moderate/severe malnutrition risk identification tripled in pilot units following improved documentation.
Conclusions:
- Multidisciplinary teams effectively improved anthropometric documentation rates on admission.
- The 80% goal was achieved for surgical and cardiac units within 26 months.
- Enhanced documentation significantly improved the identification of pediatric patients at malnutrition risk.
Background:
The objective of this quality-improvement project was to increase documentation rates of anthropometrics (measured weight, length/height, and body mass index [BMI], which are critical to identify patients at malnutrition (undernutrition) risk) from <50% to 80% within 24 hours of hospital admission for pediatric patients.
Methods:
Multidisciplinary champion teams on surgical, cardiac, and intensive care (ICU) pilot units were established to identify and iteratively test interventions addressing barriers to documentation from May 2016 to June 2018. Percentage of patients with documented anthropometrics <24 h of admission was assessed monthly by statistical process control methodology. Percentage of patients at malnutrition (undernutrition) risk by anthropometrics was compared by χ2 for 4 months before and after intervention.
Results:
Anthropometric documentation rates significantly increased (P < 0.001 for all): BMI, from 11% to 89% (surgical), 33% to 57% (cardiac), and 16% to 51% (ICU); measured weight, from 24% to 88% (surgical), 69% to 83% (cardiac), and 51% to 67% (ICU); and length/height, from 12% to 89% (surgical), 38% to 57% (cardiac), and 26% to 63% (ICU). Improvement hospital-wide was observed (BMI, 42% to 70%, P < 0.001) with formal dissemination tactics. For pilot units, moderate/severe malnutrition (undernutrition) rates tripled (1.2% [24 of 2081] to 3.4% [81 of 2374], P < 0.001).
Conclusion:
Documentation of anthropometrics on admission substantially improved after establishing multidisciplinary champion teams. Goal rate (80%) was achieved within 26 months for all anthropometrics in the surgical unit and for weight in the cardiac unit. Improved documentation rates led to significant increase in identification of patients at malnutrition (undernutrition) risk.
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