Improving the Utilization of Malnutrition Screening Tool (MST) at Cancer Head & Neck Outpatient Clinic: An Evidence-Based Quality Improvement Project

Background: Malnutrition is a significant concern among patients with head and neck cancer due to the effects of multimodal treatment on swallowing and eating. Despite its impact on morbidity and mortality, malnutrition screening in outpatient oncology clinics remains inconsistent. Early identification and intervention are essential for improving clinical outcomes, yet best practice advisory (BPA) - malnutrition screening tools (MSTs) are underutilized. Objective: This quality improvement (QI) project aimed to implement a malnutrition screening toolkit in a Head and Neck Outpatient Clinic to increase MST utilization. This led to improved identification of at-risk patients and referrals to dieticians for nutritional interventions. Methods: The project was conducted at a specialized oncology clinic in Salt Lake City, Utah. Baseline data on MST utilization were collected by live observations or shadowing of staff during the check-in and rooming process and pre-intervention surveys. The intervention involved developing and implementing a toolkit consisting of an instructional module and a tip sheet on BPA-MST use. A post-intervention survey and follow-up data collection assessed changes in MST utilization rates and referrals to dietitians. Pre- and post-intervention data were compared to evaluate the impact of the intervention. Results: Pre-intervention, 70.12% of best practice advisories (BPAs) for MST screening were addressed by staff, with a referral rate of 1.19 per 100 visits. Post-intervention, MST utilization decreased to 63.98%, with a referral rate of 1.06 per 100 visits. Although staff knowledge of MST improved, the anticipated increase in screening rates and referrals did not materialize. Staff surveys indicated that while the instructional module reinforced MST knowledge, competing clinical priorities, workflow inefficiencies, and time constraints remained barriers to consistent implementation. Conclusions: Educational interventions alone may not improve BPA-MST utilization and referral rates. Systemic factors such as staff workload, clinical workflow challenges, and the absence of structured accountability mechanisms must be addressed for sustained improvements. Leadership engagement and real-time data monitoring are crucial to ensuring consistent malnutrition screening and referral practices. Despite its limitations, the malnutrition screening toolkit holds potential as a sustainable training resource for onboarding new staff. Future efforts should focus on integrating MST prompts into mandatory workflows, automating reminders within electronic health records, and extending post-intervention follow-up to assess long-term trends.