Are Malnourished Inpatients Treated by Dietitians Active Participants in Their Nutrition Care? Findings of an Exploratory Study of Patient-Reported Measures across Nine Australian Hospitals

Jack J Bell; Alita Rushton; Kai Elmas; Merrilyn D Banks; Rhiannon Barnes; Adrienne M Young

doi:10.3390/healthcare11081172

Are Malnourished Inpatients Treated by Dietitians Active Participants in Their Nutrition Care? Findings of an Exploratory Study of Patient-Reported Measures across Nine Australian Hospitals

Healthcare (Basel). 2023 Apr 19;11(8):1172. doi: 10.3390/healthcare11081172.

Authors

Jack J Bell^{1

2}, Alita Rushton^{1

2}, Kai Elmas¹, Merrilyn D Banks³, Rhiannon Barnes³, Adrienne M Young^{3

4}

Affiliations

¹ Allied Health, The Prince Charles Hospital, Brisbane, QLD 4032, Australia.
² School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia.
³ Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia.
⁴ Centre for Health Services Research, The University of Queensland, Brisbane, QLD 4072, Australia.

Abstract

Background: Inpatient malnutrition is a key determinant of adverse patient and healthcare outcomes. The engagement of patients as active participants in nutrition care processes that support informed consent, care planning and shared decision making is recommended and has expected benefits. This study applied patient-reported measures to identify the proportion of malnourished inpatients seen by dietitians that reported engagement in key nutrition care processes.

Methods: A subset analysis of a multisite malnutrition audit limited to patients with diagnosed malnutrition who had at least one dietitian chart entry and were able to respond to patient-reported measurement questions.

Results: Data were available for 71 patients across nine Queensland hospitals. Patients were predominantly older adults (median 81 years, IQR 15) and female (n = 46) with mild/moderate (n = 50) versus severe (n = 17) or unspecified severity (n = 4) malnutrition. The median length of stay at the time of audit was 7 days (IQR 13). More than half of the patients included had two or more documented dietitian reviews. Nearly all patients (n = 68) received at least one form of nutrition support. A substantial number of patients reported not receiving a malnutrition diagnosis (n = 37), not being provided information about malnutrition (n = 30), or not having a plan for ongoing nutrition care or follow-up (n = 31). There were no clinically relevant trends between patient-reported measures and the number of dietitian reviews or severity of malnutrition.

Conclusions: Malnourished inpatients seen by dietitians across multiple hospitals almost always receive nutritional support. Urgent attention is required to identify why these same patients do not routinely report receiving malnutrition diagnostic advice, receiving information about being at risk of malnutrition, and having a plan for ongoing nutrition care, regardless of how many times they are seen by dietitians.

Keywords: dietitian; engagement; hospitals; malnutrition; nutrition therapy; participation.

Abstract

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