Under-Identification of Malnutrition Within an Inpatient Hospital Setting

Malnutrition contributes to significant health and economic burden. A 2022 Malnutrition Point Prevalence Survey (PPS) at Austin Health, Melbourne, reported a 40% prevalence rate, consistent with international studies. However, despite robust screening and referral processes, 28% of at-risk or malnourished patients were not receiving dietetic care on the PPS day. This study aimed to evaluate the rate and timing of electronic malnutrition screening tool (eMST) completion in adult inpatients against local hospital guidelines, compare the accuracy of nursing completed eMST with dietitian completed MST and identify common sources of error in screening completion and potential contributors for those patients who were identified as at risk of or with malnutrition and not receiving dietetic care.

A retrospective case series of dietitian referrals, weights, time of eMST completion and MST results between admission and the PPS day were assessed for timeliness against hospital guidelines and accuracy based on available weight history, dietitian completed MST and nutrition impact symptoms documented in the electronic medical record (EMR).

On the day of the PPS 48 patients at-risk of (n = 19) or malnourished (SGA B n = 27, SGA C n = 2) were not receiving dietetic care. Of these, 60% (n = 29) missed dietetic care due to inaccurate MST completion. No weight loss (n = 20) was incorrectly reported despite patient reports or EMR data indicating otherwise. 35% of patients (n = 17) were weighed within 24 h of admission as per hospital guideline. 65% of MSTs completed during the morning nursing shift were inaccurate, compared with 48% during the afternoon and 36% during the night shift.

This study examining the alignment between real-world screening practices and institutional guidelines for patients at risk of malnutrition identified clear gaps in the timely and accurate completion of MST screening and weight documentation. A multitude of factors likely influence this including nursing staff capacity, flawed design of EMR systems, and suboptimal protocol sequencing. Future research applying systems-level thinking is required.