The Joint Commission on Accreditation of Hospitals is putting increasing demands on medical centers to show how interdisciplinary monitoring can improve quality of care. Nan Musson and her colleague Michael Silverman provide an example of an interdisciplinary team monitoring project that resulted in considerable cost savings to their hospital

This TQM/CQI project was designed to improve prescribing and utilization of liquid nutritional supplements. Outpatients receiving nutritional supplements were assessed by an interdisciplinary team. Patients not meeting the criteria for continued use were referred for nutritional counseling and monitoring.

Major causes for nutritional decline can be divided into three categories: social, psychological, and medical. Social causes may include social isolation, poor financial status, or decline in ability to complete independent activities of daily living, while psychological factors may include depression, alcoholism, or anorexia. Medical causes of nutritional decline include disorders that interfere with self-feeding and swallowing (i.e., cerebrovascular accident, Parkinson's Disease, Alzheimer's Disease, chronic obstructive pulmonary disease or candidiasis), disorders that increase metabolism (i.e., hyperthyroidism) or disorders of malabsorption (i.e., gluten enteropathy). In addition, over-prescription of medications or restricted diets can increase the risk for iatrogenic decline in nutrition.