NR 531 Week 8 Executive Briefing for Decision Example

Executive Briefing for Decision: Extend the Automatic Dietitian Consult From Medical and Surgical Units to Every Adult Inpatient Unit, Written to Survive Being Summarized by Someone Who Did Not Write It

Student Name

College of Nursing, Chamberlain University

NR 531: Nursing Leadership in Healthcare Organizations

Instructor Name

Month Day, Year

Executive Briefing for Decision: Extend the Automatic Dietitian Consult From Medical and Surgical Units to Every Adult Inpatient Unit, Written to Survive Being Summarized by Someone Who Did Not Write It

For Decision

Request. Approve extending the automatic dietitian consult protocol from the adult medical and surgical units to all adult inpatient units, including intensive care and oncology, from July 1, with 0.3 of an additional dietitian position in next year's budget.

Presenter. Chief nursing officer, on behalf of the Nutrition Care Committee. Prepared by. Nurse manager, adult medical unit.

The Situation

Since February 1, on the medical and surgical units, an admission score of 2 or more on the Malnutrition Screening Tool has placed a dietitian consult on its own, under a protocol the medical staff's executive committee signed in December. The tool is a validated two-question screen for adult acute hospital patients (Ferguson et al., 1999). Before the protocol, a nurse had to page a provider for the consult order.

Three numbers summarize the first 90 days, drawn from the electronic health record by the quality analyst. Half of all at-risk patients now meet a dietitian within 0.9 days of screening, against 2.6 days before the change. The share of at-risk patients who left the hospital with a documented nutrition plan rose from 38% to 71%. Consults averaged 14 a day, within the capacity funded by the in-year exception approved in January.

The intensive care and oncology units still use the old process. Patients on those units are among the most likely to be malnourished, and their screen-to-assessment time over the same 90 days was 2.4 days.

Options Considered

Option A: Extend to all adult inpatient units (recommended). Consults would rise by about four a day. Cost: 0.3 of a dietitian position, about $27,500 a year, added to the 0.6 already in next year's budget request. Intensive care would keep its existing nutrition support team for patients on tube feeding or parenteral nutrition; the protocol would cover the rest.

Option B: Keep the protocol on medical and surgical units only. No added cost. The gap between units would remain, and the patients with the highest risk would continue to wait longest.

Option C: Extend with a tiered response and no added staff. Dietitians would see scores of 4 or 5 within 24 hours and 2 or 3 within 72 hours on all units. No added cost, but the bulk of positive screens fall in the lower band, and many of those patients would go home before a dietitian arrived. On the medical and surgical units, this would also lengthen response times that have already improved.

Option A is recommended for three reasons. It treats patients on every adult unit by the same standard, which staff who float between units have asked for. It builds on a process that has already worked for 90 days, so the risk of the change is small. And it it closes the gap on the units with the most malnutrition at the lowest added cost. A national interdisciplinary call to action listed acting quickly once risk is found among its six principles for hospital nutrition care (Tappenden et al., 2013). Options B and C each leave that principle unmet for a known group of patients.

Risks

Consult volume could exceed the estimate, especially in oncology, where most patients may screen positive. The Nutrition Care Committee can adjust response times within its charter if volume exceeds capacity, and will report monthly. Intensive care physicians may see the protocol as overlapping with the nutrition support team; the protocol excludes patients already followed by that team, and the intensive care medical director has reviewed the exclusion. The 90-day results come from a period that included the winter respiratory season, and figures may differ in summer. None of these risks is large enough to change the recommendation, but each will be tracked.

Ownership and Return

The clinical nutrition manager, as chair of the Nutrition Care Committee, owns delivery. The nurse informaticist owns the electronic build for the new units, which uses the existing rule and needs about two weeks in the change queue. The committee will return to this group in January with six months of results on all units, reporting the same three measures used above.

Consistency across a hospital is itself one of the aims set out in the published argument that hospital malnutrition deserves a nationwide target (Guenter et al., 2015). Approving Option A would make the hospital's approach consistent across every adult unit.

Background Available on Request

The full 90-day report, the approved protocol, the Nutrition Care Committee charter and the January resource request are attached and available to any member of the leadership team. They are not needed for the decision. The decision needed today is whether the protocol applies to every adult inpatient or only to those on two kinds of unit, and the numbers above are enough to make it.

Note on How This Briefing Was Written

This section is for the course, not for the leadership team. The briefing will not be presented by me. The chief nursing officer will carry it into a meeting with a crowded agenda, summarize it in a sentence or two and ask for a decision. I therefore wrote it so that its first line could stand alone: a label saying it is for decision, and one sentence saying what is being decided. The situation carries three numbers, each attributed to the quality analyst's report, because more numbers would not be remembered. The alternatives are described fairly, including their advantages, so that the recommendation looks chosen rather than assumed. Risks are stated plainly, without reassurance. I also cut two paragraphs from the first draft: one on the history of the protocol's approval and one on the national evidence on malnutrition. Both were accurate, and neither would change the decision. They now sit in the attachments, where anyone who wants them can find them. The test I used for every sentence was whether the chief nursing officer could say it aloud in a meeting with the paper left on the table and still be correct. The last lines name the owner and the date the item returns, so that the leadership team knows what happens after it says yes. Everything else is attached rather than included, because the briefing's job is to get a decision, not to tell the whole story.

References

Ferguson, M., Capra, S., Bauer, J., & Banks, M. (1999). Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition, 15(6), 458-464. https://doi.org/10.1016/S0899-9007(99)00084-2

Guenter, P., Jensen, G., Patel, V., Miller, S., Mogensen, K. M., Malone, A., Corkins, M., Hamilton, C., & DiMaria-Ghalili, R. A. (2015). Addressing disease-related malnutrition in hospitalized patients: A call for a national goal. The Joint Commission Journal on Quality and Patient Safety, 41(10), 469-473. https://doi.org/10.1016/S1553-7250(15)41061-X

Tappenden, K. A., Quatrara, B., Parkhurst, M. L., Malone, A. M., Fanjiang, G., & Ziegler, T. R. (2013). Critical role of nutrition in improving quality of care: An interdisciplinary call to action to address adult hospital malnutrition. Journal of Parenteral and Enteral Nutrition, 37(4), 482-497. https://doi.org/10.1177/0148607113484066