Abstract
Background: Malnutrition is prevalent in acute care hospital patients and has many negative health outcomes, such as increased length of stay, increased risk of readmission, morbidity, and mortality. Christchurch Hospital malnutrition protocol expects all patients to be screened for malnutrition on admission, but there is no expectation for follow-on care at discharge for those who are at risk of malnutrition (scored Malnutrition Screening Tool (MST)≥2). This study aimed to audit the Christchurch Hospital screening practices, assess agreement between nurse and student MST scores, identify the characteristics and treatment of participants at risk of malnutrition, and describe the post-discharge outcomes and readmission rates in participants at risk of malnutrition.
Methodology: This was a two-part (Phase One and Phase Two) observational study of patients admitted to two general medicine wards, one oncology/gastroenterology ward and one respiratory ward. Phase one data was collected over an eight-week period between July and September 2021. This involved an audit of the rate of malnutrition screening by nurses on patient admission, and the agreement between nurse and student dietitian MST scores. Patients who were scored an MST≥2 in Phase One by the student dietitian were eligible for Phase Two. Patients eligible during a previous recruitment period between March and June 2021 were also included in Phase Two of this study. Phase Two data collected included prevalence of malnutrition (through Subjective Global Assessment (SGA)), characteristics (anthropometry and dietary intake), inpatient malnutrition care (dietitian referral and intervention), length of stay and malnutrition documentation, and 30-day post-discharge nutrition status and environment. Data was analysed as a total population and by subgroups of those who received dietetic intervention in hospital and those who did not. Ethical approval was granted by the University of Otago Academic Committees and Services, and local authority to conduct the research at Christchurch hospital was provided by the Canterbury District Health Board Research Office.
Results: Phase One included data from 232 participants. MST screening by nurses was high (80.6%), but of the 187 participants who were screened by a nurse, 80 (42.7%) received the same score by student dietitian. Student dietitian MST screening found that 87 (37.5%) participants were at malnutrition risk. Of those eligible for Phase Two, 39 consented and 36 (94.7%) were found to be malnourished (SGA B or SGA C). Participants that received dietetic care in hospital were more likely to receive oral nutrition support (ONS) post discharge, have dietitian consultation post discharge, have longer LOS, be more severely malnourished (SGA C) (3 (33.3%) vs 2 (6.9%)), have mid-arm muscle circumference (7 (77.8%) vs 9 (34.6%)), and fat-free mass index (8 (88.9%)vs 7 (29.2%)) <10th percentile for age and sex, and have a body mass index <25kg/m2 (9 (100%) vs 14 (48.3%)).
Conclusion: Nurse malnutrition screening rates were high, although agreement of MST scores between nurse and student dietitians was moderate. Participants who received dietetic care in hospital were more likely to receive a community dietitian referral and/or ONS or an ONS prescription on discharge compared to those who did not receive dietetic care.