The Updated Global Malnutrition Composite Score Clinical Quality Measure: Its Relevance to Improving Inpatient Clinical Outcomes and Health Equity

Quality improvement has existed in health care for centuries with a dramatic transformation over time, largely motivated by the academic health quality movement. Throughout this evolution, the Centers for Medicare and Medicaid Services have been at the forefront of the development and provision of quality measures for health care in a variety of settings, including acute care. Quality initiatives aid in the evaluation of patient care to encourage quality improvement efforts, determine pay-for-performance rates, and help patients and consumers evaluate their care providers. The addition of the Global Malnutrition Composite Score as an electronic Clinical Quality Measure in 2022 highlights the key role nutrition plays in outcomes and quality of hospitalized patients. With this, credentialed nutrition and dietetics practitioners lie front and center for the development of quality improvement processes to help promote high quality standards of nutrition care, improve length of stay, and reduce health care costs and readmissions while addressing malnutrition, health equity, and nutrition care as a human right. As the Global Malnutrition Composite Score steward, it is the obligation of the Academy of Nutrition and Dietetics and the Commission on Dietetic Registration to promote the measure and support credentialed nutrition and dietetics practitioners in advocating for the implementation of this measure. Therefore, the purpose of this practice update is to provide necessary information to credentialed nutrition and dietetics practitioners and other health care leaders related to the history and implementation of the Global Malnutrition Composite Score, along with relevant updates to the measure and practice implications.

[Use of a blood recuperating device. Total knee arthroplasty]

The authors evaluate the adoption of a protocol to recuperate blood from drainage during surgery for knee prosthesis. They carried out a prospective study on 19 patients diagnosed with knee arthrosis and who underwent surgery for Total Knee Arthroplasty from September 2006 through June 2007. The medical instrument used was Bellovac, produced by Astral Tech. In the Post anesthesia Reanimation Unit, four patients received a homologous transfusion (27.50%). Prior to the adoption of this protocol, the rate of transfusion was 37%. Hemoglobin during preoperative procedures was not a risk factor for a homologous transfusion. This is associated with the volume drained and reinserted. Patients who received a transfusion had drained 450 cc or more. The study did not record any complication due to the use of the recuperating device. The use of this device made it possible to decrease homologous blood transfusions.