“Strength in Screening”: Improving Malnutrition & Sarcopenia Detection in the Emergency Department

Background Malnutrition, sarcopenia, and frailty are interconnected conditions that can exacerbate one another. They remain under-recognized and under-treated contributing to adverse health outcomes(1). Timely medical, nutritional, and physical interventions can mitigate harm and enhance patient outcomes. While this hospital employed the Malnutrition Universal Screening Tool (MUST), no formal screening tool was used to assess sarcopenia risk. A quality improvement initiative was launched to evaluate malnutrition and sarcopenia risk among patients seen by the Frailty Intervention Team (FIT) in the emergency department (ED) and to strengthen the referral pathway for nutritional intervention. Methods Guided by the Plan-Do-Check-Act framework, the project involved: Results The initial audit revealed poor MUST screening compliance (4%), a high falls history (51%), and low dietetic referral rates (21%). Following implementation, malnutrition screening improved to 85%, with 11% of patients identified as malnourished and 38% at risk. Falls history remained high (57%), and 54% of patients had a SARC-f score ≥4, indicating significant sarcopenia risk. Dietetic referrals increased to 51%. Conclusion This initiative significantly improved screening and referral for malnutrition and sarcopenia among frail older adults in the ED. Given the high sarcopenia risk identified, incorporating hand grip strength assessment may enhance diagnostic accuracy. Ongoing education and monitoring will be crucial to sustaining improvements in clinical practice. Reference 1. Bowler, C. et al. Nutritional Screening, Initial Management and Referral for Older People with Sarcopenia or Frailty-Results from a UK-Wide Survey. Journal of Frailty, Sarcopenia and Falls 2024;9.2:131.