The prevalence of malnutrition in hospitals can be reduced: results from three consecutive cross-sectional studies

AIMS: To assess and compare the rates of malnutrition in Hammersmith Hospital NHS Trust over a 5-year period following changes in hospital nutrition care strategies. METHODS: Design: Three consecutive cross-sectional studies carried out in 1998, 2000 and 2003. SETTING: Inpatients at Hammersmith Hospital NHS Trust. PARTICIPANTS: A total of 2283 inpatients aged over 16 years old, 686 in 1998, 780 in 2000, 817 in 2003. Inpatients excluded: ventilated patients, ante/post-natal women and people aged <16. INTERVENTIONS: Improvements in the catering service and nutrition education provision in 2000, and the implementation of a nutrition screening tool and 'Better Hospital Food' in 2003. MAIN OUTCOME MEASURE: Prevalence of malnutrition. RESULTS: There was a reduction in the prevalence of malnutrition in 2000 and 2003 from baseline data in 1998 (1998: 23.5%, 161/686; 2000: 20.4%, 159/780; 2003: 19.1%, 156/817; P<0.001). The odds ratio of being either at risk of malnutrition or malnourished was reduced in both 2000 and 2003 by approximately 33% (P=0.001). Indicators of good nutritional practice also improved: Weighing patients on admission increased from 37.5% (257/686) in 1998, to 42.9% (335/780) in 2000, and 59.6% (487/817) in 2003 (P0.001). Dietetic referrals also increased from 31.5% (216/686) in 1998 to 41.6% (340/817) in 2003 (P<0.001)(no change in 2000, 31%, 242/780). Appropriate referrals also improved, results showing that the proportion of malnourished patients who were referred showed a dramatic increase in 2003 (1998: 91/161, 56.5%; 2000: 85/159, 53.5%; 2003: 111/156, 71.2%; P=0.003). CONCLUSIONS: The prevalence of malnutrition in hospital can be influenced by the implementation of a variety of nutrition care strategies, which target identification of malnutrition and its treatment.     

Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients

BACKGROUND: About 25-40% of hospital patients are malnourished. With current clinical practices, only 50% of malnourished patients are identified by the medical and nursing staff. OBJECTIVE: The objective of this study was to report the cost and effectiveness of early recognition and treatment of malnourished hospital patients with the use of the Short Nutritional Assessment Questionnaire (SNAQ). DESIGN: The intervention group consisted of 297 patients who were admitted to 2 mixed medical and surgical wards and who received both malnutrition screening at admission and standardized nutritional care. The control group consisted of a comparable group of 291 patients who received the usual hospital clinical care. Outcome measures were weight change, use of supplemental drinks, use of tube feeding, use of parenteral nutrition and in-between meals, number of consultations by the hospital dietitian, and length of hospital stay. RESULTS: The recognition of malnutrition improved from 50% to 80% with the use of the SNAQ malnutrition screening tool during admission to the hospital. The standardized nutritional care protocol added approximately 600 kcal and 12 g protein to the daily intake of malnourished patients. Early screening and treatment of malnourished patients reduced the length of hospital stay in malnourished patients with low handgrip strength (ie, frail patients). To shorten the mean length of hospital stay by 1 d for all malnourished patients, a mean investment of 76 euros (91 US dollars) in nutritional screening and treatment was needed. The incremental costs were comparably low in the whole group and in the subgroup of malnourished patients with low handgrip strength. CONCLUSIONS: Screening with the SNAQ and early standardized nutritional care improves the recognition of malnourished patients and provides the opportunity to start treatment at an early stage of hospitalization. The additional costs of early nutritional care are low, especially in frail malnourished patients.     

A quality improvement nutrition screening and intervention program available to Home and Community Care eligible clients

Objective:  To develop and implement a nutrition screening and dietetic referral system for Home and Community Care (HACC) eligible clients.
Design:  Quality improvement project utilising a prospective, observational design.
Setting:  Sixteen Australian organisations caring for HACC eligible clients.
Subjects:  One thousand one hundred and forty-five HACC eligible clients (mean age 76.5 ± 7.2 years) were screened for nutritional risk during 2003–2005.
Interventions:  Nutrition screening was conducted by trained project officers, allied health staff, community care coordinators and nursing staff using a modified version of the malnutrition screening tool (MST). Dietitians performed a nutrition assessment using the scored Patient Generated-Subjective Global Assessment (PG-SGA) and provided individualised nutrition counselling for those identified to be at risk of malnutrition and agreeing to treatment.
Results:  According to the MST, 170 clients (15%) were identified as being at risk of malnutrition. Of these, 75 (44%) agreed to the dietetic referral and PG-SGA assessment, and 57 were subsequently assessed as malnourished (PG-SGA category B or C), suggesting a malnutrition prevalence between 5% and 11%. Of the 34 malnourished clients receiving multiple dietetic reviews (mean 4.1 ± 2.0 per client), 28 improved, with 17 achieving a well-nourished PG-SGA A rating.
Conclusion:  The development and implementation of a nutrition screening and referral system can identify HACC eligible clients who would benefit from services provided by a dietitian. Further research should identify the reasons why some HACC eligible clients are reluctant to be referred to a dietitian.     

消化道恶性肿瘤化疗病人营养状况现况调查和影响因素分析

目的:通过调查消化道恶性肿瘤单纯行化疗病人的营养状态及支持的现况,并分析相关影响因素,为后期制定针对性的营养支持护理方案提供理论依据。方法:选取2019年1月~2019年9月上海长海医院757例消化道恶性肿瘤单纯行化疗的病人为调查对象,运用营养风险筛查2002(NRS 2002)评分表和病人主观整体营养状况评估量表(PG-SGA)进行营养不良分级,对相关影响因素进行分析。结果:757例消化道肿瘤病人中存在营养风险的占35.4%,其中可疑营养不良占19.4%,中度营养不良占54.8%,重度营养不良占25.7%。最近2周体质量变化、有无"无食欲"、"呕吐"、"腹泻"、"疼痛"等症状以及年龄≥65岁是消化道肿瘤化疗病人营养不良的主要影响因素。营养支持现状:87.3%的病人接受营养教育,66.4%接受营养支持,营养支持并发症发生率高。结论:单纯化疗的消化道肿瘤病人营养不良发生率高,化疗后胃肠道不良反应的发生以及营养支持并发症的发生是影响营养状况的主要原因,做好症状管理以及规范营养支持是改善该类病人营养状况的主要方向。     

Creating a clinical nutrition registry: prospects, problems, and preliminary results

There is a tremendous gap in the information available to support the practice of hospital-based dietitians and to address the issue of how the risk of developing protein-energy malnutrition can be avoided in the majority of patients. This article describes the rationale and benefits of creating a nutrition registry of within-hospital clinical nutrition care. A nutrition registry is made up of observational data, collected on an ongoing basis, of nutritional interventions provided to hospitalized patients. It is the first step in data gathering to demonstrate the effectiveness of clinical nutrition interventions. The methods and preliminary results of a nutrition registry that was established at The University of Illinois Medical Center, Chicago, III, are presented. Using subjective global assessment, 55% (257 of 467) of patients at admission and 60% (280 of 467) of patients at discharge were moderately or severely malnourished. Patients that were normal nourished at admission and became moderately or severely malnourished had higher hospital charges ($40,329 for moderately malnourished patients, $76,598 for severely malnourished patients) than those that remained normal nourished ($28,368). This pattern held independent of admission nutritional status. Major challenges in implementation of a registry into the responsibilities of the staff dietitian are reviewed. The conclusion of this study is that nutrition registries can be established and will provide the much needed baseline data to document the impact of nutrition interventions on outcomes of medical care.     

新疆地区三级甲等医院住院患者营养风险、营养不良(不足)、超重和肥胖发生率及营养支持应用状况

目的调查新疆地区三级甲等医院6个专科住院患者营养风险、营养不良（不足）、超重和肥胖发生率及营养支持应用状况。方法采用定点连续抽样的方法,收集新疆地区5所三级甲等医院中6个专科的住院患者,符合营养风险筛查2002（NRS2002）评分≥3分为有营养风险,体重指数（BMI）〈18．5kg／m2（或白蛋白〈30g／L）为营养不足。在患者人院次日早晨进行NRS2002筛查,并调查2周内（或至出院时）的营养支持状况,分析营养风险和营养支持之间的关系。结果共调查4036例,其中3913例完成NRS2002筛查,营养不良（不足）与营养风险的发生率分别为8．4％和34．2％,实际营养支持率为10．2％,其中肠外营养为8．5％,肠内营养为1．7％,肠外营养：肠内营养为5．1：1。结论通过对新疆地区三级甲等医院的调查发现,NRS方法简单、快捷、方便,能够发现住院患者的营养风险,为进行合理营养支持提供依据,应向临床推广。     

Prevalence and documentation of malnutrition in hospitals: A case study in a large private hospital setting

Objectives: To determine the prevalence of malnutrition and whether the malnourished participants were being identified and documented as malnourished. To evaluate the impact of poor documentation on financial reimbursement to the hospital. Subjects: Three hundred and twenty‐four inpatients from a total of 690 randomly selected patients consented to participate in the study. Design and setting: Subjective Global Assessment (SGA) was used to assess the nutritional status of inpatients. There were 1906 patients were admitted over a three‐month period. Of these, 1860 were eligible and 690 were randomly selected from computer generated ward lists. The referral rate for nutrition intervention of malnourished participants was determined by viewing the patient medical records retrospectively. The Australian National Diagnostic Related Group (AN‐DRG) of the malnourished subjects, not documented in the medical record as malnourished, were redetermined with the addition of the malnutrition code. The potential shortfall in financial reimbursement to the hospital was calculated by subtracting the average costing based on original AN‐DRGs from the average costing based on the revised AN‐DRGs. Main outcome measures: Prevalence of malnutrition, levels of malnourished patients identified and documented, revenue losses under case payment system. Statistical analyses: Logistic regression analyses were used to evaluate group differences in sex across SGA categories and to investigate predictors of referral versus non referral. Analysis of variance was used to evaluate group differences in age across SGA categories. Results: One hundred and twenty‐seven (42.3%) of the 324 subjects were malnourished. Only one of 137 malnourished patients was documented as malnourished in the medical records and only 21 (15.3%) were referred for nutrition intervention. The inclusion of the malnutrition code to the AN‐DRG of the identified malnourished patients highlighted a shortfall of $125 311 in reimbursements to the hospital. Conclusions: The degree of malnutrition in this hospital is similar to that found internationally. Malnourished patients are not being identified using the current referral method. Failure to flag malnourished patients requiring nutrition intervention potentially impacts on length of stay, hospital costs and patient outcomes and ultimately results in a shortfall for case payment funded institutions.     

Nutrition au cours des radiothérapies et chimiothérapiesNutritional support during cancer chemotherapy and radiotherapy

Nutritional support for cancer patients treated with radiotherapy and chemotherapy are strongly requested with regard to the frequent malnutrition at time of diagnosis. Furthermore, the malnutrition often progresses with adverse effects of therapy and disease progression. Nutritional screening and assessment are essential. Dietetic care is mandatory for patients with malnutrition or at risk of malnutrition when they are still able to eat. But this oral nutritional support is frequently unable to maintain sufficient nutritional intakes with regard to tumour effect or treatment toxicity. Enteral or parenteral nutrition must be provided to patients unable to absorb adequate quantity of nutrients for a prolonged period. The primary goal is to avoid, especially for malnourished patients, further nutritional degradation which can lead to treatment interruptions, complications or increased risk of death. Routine administration of artificial nutrition has been tested during radiotherapy and chemotherapy but results are conflicting and data are missing for severely malnourished patients. No benefits in terms of treatment toxicity, tumour response, risk of complications and finally mortality have been demonstrated for routine use of artificial nutrition. Most decisions for indication of nutritional support, route of administration and quality of artificial nutrition in this field can't rely today on evidence-based medicine. However, artificial nutrition can provide nutrients and hydration necessary to maintain comfort and to improve survival for patients unable to eat sufficient nutrition for a prolonged period.     

营养支持小组建立的意义

目的：探讨建立营养支持小组对院内临床营养支持疗效的影响。方法：将1999年1月－2000年4月间的317例病人以我院营养支持小组成立时为界,分为成立前（BET组）、成立后（AET组）两组。对两组病人营养持状况及其并发症发生情况作对照组。结果：AET组营养支持前接受全面的营养状况评估、营养支持治疗中进行营养监测、肠外营养选择TNA、方式及中心静脉输注途径、肠内营养持采用管饲方式的人数比例较BET组均有显著提高（P＜0．05）。AET组的肠外营养支持中导管及代谢并发症发生率、肠内营养支持中胃肠道及代谢并发症发生率较BET组有显著下降（P＜0．05）。结论：建立营养支持小组能使使临床营养支持的规范化程度提高,有效地降低营养支持相关并发症的发生率,是推动营养支持在临床上更为有效、安全、合理应用的一种良好方式。     

Malnutrition screening and early nutrition intervention in hospitalised patients in acute aged care: A randomised controlled trial

Objectives

High rates of malnutrition have been reported in the older hospitalized patient population. This is recognised to impact on patient outcomes and health costs. This study aimed to assess the impact of nutrition screening and intervention on these parameters.

Design

Randomised controlled prospective study.

Setting

The study was performed in the acute geriatric medicine wards of the Prince of Wales Hospital, Sydney Australia.

Participants

All patients admitted to these wards under a geriatrician with an expected length of stay of at least 72 hours were considered for the study.

Intervention

Patients were screened on admission for malnutrition using the Mini Nutritional Assessment (MNA) tool and randomly assigned to control or intervention groups. Intervention patients were immediately commenced on a malnutrition care plan (MCP). Control patients were only commenced on a MCP if referred by clinical staff.

Measurements

Length of stay (LOS), weight change and frequency of readmission to hospital were compared between the groups.

Results

143 patients were screened. 119 were identified as malnourished (MN) or at risk of malnutrition (AR). Overall LOS was not different between the two groups (control v. intervention: 13.4 ± 1.3 days v. 12.5 ± 1.2 days, p=0.64). However there was a significant decrease in LOS in the MN (control v. intervention: 19.5 ± 3days v. 10.6 ± 1.6 days, p=0.013) and a trend to reduced readmissions. There was no difference in weight change over admission between the groups. Without screening, clinical staff identified only a small proportion of malnourished patients (35% of MN and 20% of AR).

Conclusions

Malnutrition in the older hospital population is common. Malnutrition screening on hospital admission facilitated targeted nutrition intervention, however length of stay and representations were only reduced in older malnourished patients with an MNA score less than 17.     

老年肝胆外科住院患者的动态营养风险筛查

目的调查老年肝胆外科住院患者营养风险、营养不足发生率以及营养支持应用状况。方法采用定点连续抽样,对156例老年肝胆外科住院患者（≥65岁）人院后第2天早晨和住院2周或出院时进行营养风险筛查2002（NRS 2002）的动态描述性研究。结果NRS 2002的适用率为96．8％（151／156）。患者总的营养风险发生率为36．9％（57／156）,营养不足发生率为26．2％（41／156）。住院时间大于2周的患者营养风险和营养不足发生率分别为49．6％和36．7％,住院时间小于2周的患者营养风险和营养不足发生率分别为37．3％和21．4％,两者相比差异具有统计学意义（P〈0．05）。存在营养风险和无营养风险患者营养支持率分别为64．1％和17．4％。其中,接受大手术患者中有营养风险和无营养风险患者的营养支持率分别为87．9％和36．8％,接受中、小手术患者中有营养风险和无营养风险患者的营养支持率分别为41．3％和9．6％。结论NRS 2002适用于老年肝胆外科住院患者的营养风险筛查。住院时间大于2周老年肝胆外科住院患者营养风险和营养不足发生率反而有所增加。临床营养支持在肝胆外科需要更加重视住院患者的营养问题,临床上存在肠外、肠内营养的不合理应用。     

Hospital-wide screening improves basis for nutrition intervention

The prevalence of malnutrition and need for nutrition intervention were evaluated at the time of admission for 500 consecutive patients at Cleveland Memorial Hospital, a 300-bed acute-care community hospital, in Shelby, NC. The association between the prescribed diet and the need for special nutrition intervention was emphasized. Results indicate that 31% of patients receiving routine diets (regular, soft, full liquid, clear liquid, NPO) and 33% of patients receiving modified diets were malnourished at the time of admission. Chi-square analysis indicated that there was no significant difference (p less than or equal to .05) in the prevalence of malnutrition or the need for special nutrition intervention between the two groups. Yet, many hospital nutrition services are organized to direct their activities primarily to patients receiving modified diets. It is suggested that dietetic practitioners implement a hospital-wide screening process so that patients with special nutrition needs can be identified and appropriate support regimens can be planned.     

A Review of Nutrition Support Guidelines for Individuals with or Recovering from COVID-19 in the Community

COVID-19 negatively impacts nutritional status and as such identification of nutritional risk and consideration of the need for nutrition support should be fundamental in this patient group. In recent months, clinical nutrition professional organisations across the world have published nutrition support recommendations for health care professionals. This review summarises key themes of those publications linked to nutrition support of adults with or recovering from COVID-19 outside of hospital. Using our search criteria, 15 publications were identified from electronic databases and websites of clinical nutrition professional organisations, worldwide up to 19th June 2020. The key themes across these publications included the importance in the community setting of: (i) screening for malnutrition, which can be achieved by remote consultation; (ii) care plans with appropriate nutrition support, which may include food based strategies, oral nutritional supplements and referral to a dietitian; (iii) continuity of nutritional care between settings including rapid communication at discharge of malnutrition risk and requirements for ongoing nutrition support. These themes, and indeed the importance of nutritional care, are fundamental and should be integrated into pathways for the rehabilitation of patients recovering from COVID-19.     

Nutritional care in care homes: experiences and attitudes of care home staff

Background: The Food Award Barnsley (FAB) is organised for care homes that meet nutritional criteria based on national recommendations. Research (Thompson, 2003) highlighted that meeting FAB criteria is not an assurance that residents are receiving adequate nutrition. This is supported by studies demonstrating multiple individual/organisational factors influencing rates of malnutrition in care establishments (Abbasi & Rudman 1994; Health Advisory Services, 2000). To develop a training intervention to support FAB, an understanding of the role, perceptions and attitudes of care staff in the process of nutritional care was required. The main research aims were to describe staff's experiences of nutritional care of service users, to explore staff's attitudes towards nutritional care of service users and to highlight issues relating to nutritional care which could be considered when developing training programmes or provide the basis for future research. Methods: A care home that held the silver FAB, offered nursing and residential care and had more than 20 beds was chosen. Maximum variation sampling was used to select a cross‐section of staff in terms of position, level of education and length of service. Twelve semi‐structured interviews were recorded, transcribed and analysed using the template approach as developed by King (1998). The process from which the conclusions of the study were drawn was made clear through documentation. The audit trail within the final report demonstrates dependability and confirmation and hence the rigour of the study. Results: In general staff felt they were effective in identifying and addressing issues of malnutrition. However, from a dietetic perspective there was a fragmented approach to nutritional care. At all levels ‘confused role expectations’, lack of clear action planning, poor communication and attitudes towards malnutrition represented a significant barrier to good nutritional care within the home. Despite using a nutritional screening tool, staff relied more heavily on their own subjective judgement to identify residents who they thought were malnourished. Care home staff at all grades considered a poor appetite to be a ‘normal’ part of ageing and some felt that in conditions such as Parkinson's Disease it was expected that residents would lose weight. Portion sizes were reduced regardless of the need for compensation for reduced nutritional intake. Discussion: The lack of a coherent approach to nutritional care coupled with poor communication at all levels resulted in the risk that residents were not receiving appropriate nutritional care. Staff relied on their own judgement, not an objective measure; to identify residents they thought were at risk of malnutrition. These problems were compounded by attitudes of staff at all levels to nutrition, weight and ageing which resulted in lack of intervention in residents who were malnourished or at risk of malnutrition. Conclusion: This study highlights barriers to changing the process of nutritional care within the home which should be addressed through training, whilst ensuring national nutritional standards for provision of food are met. References Abbasi, A. & Rudman, D. (1994) Under nutrition in the nursing home: Prevalence, consequences, cause and prevention. Nutr. Rev. 52, 113–122. Health Advisory Services. (2000) “Not Because they are Old”. An Independent Inquiry into the Care of Older People on Acute Wards in General Hospitals. London: Health Advisory Services. King, N. (1998) Template analysis. In Qualitative Methods and Analysis in Organisational Research. eds C. Cassell & G. Symons, pp. 118–134. London: Sage. Thompson, L. (2003) Nutritional Perceptions among Staff Working in a Care Home for Elderly People and the Potential for Nutrition Education. BSc thesis, Leeds Metropolitan University.     

Development of a valid and reliable malnutrition screening tool for adult acute hospital patients.

Nutrition screening identifies individuals who are malnourished or at risk of becoming malnourished and who may benefit from nutrition support. The aim of this study was to develop a simple, reliable and valid malnutrition screening tool that could be used at hospital admission to identify adult acute patients at risk of malnutrition. The sample population included 408 patients admitted to an Australian hospital, excluding pediatric, maternity, and psychiatric patients. The ability of various nutrition screening questions to predict subjective global assessment (SGA) were examined in contingency tables. The combination of nutrition screening questions with the highest sensitivity and specificity at predicting SGA was termed the malnutrition screening tool (MST), and consisted of two questions regarding appetite and recent unintentional weight loss. Subjects who were at risk of malnutrition according to the MST had significantly lower mean values for the objective nutrition parameters (except immunologic parameters) and longer length of stays than subjects who were not at risk of malnutrition. Therefore convergent and predictive validity of the MST was established. The interrater reliability of the malnutrition screening tool was high (93-97%). The MST is a simple, quick, valid, and reliable tool which can be used to identify patients at risk of malnutrition.     

Assessment of nutritional status on hospital admission: nutritional scores

Malnutrition is still a largely unrecognized problem in hospitals. Malnutrition in hospitalized patients is generally related to increasing morbidity and mortality, and costs and length of stay. The aim of this study was to assess the nutritional status of patients on admission to a general hospital using different nutritional scores and to test the sensitivity and specificity of these scores. Sample population included 60 patients (55% male; 45% female) selected (aged 65.6+/-15.9 y) at random by using a computer software program. The nutritional state assessment was performed within 48 h of admission, using different nutritional indices (Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Gassull classification, Instant Nutritional Assessment (INA) and a combined index). About 78.3% of patients were found to be malnourished on admission. The frequency of malnutrition degree varied from 63.3% as assessed by the SGA to 90% with the NRI. Malnutrition severity was not related to the diagnosis. However, an elderly population was associated with a higher prevalence of malnutrition. INA was the best single score to identify patients who are malnourished or at risk of malnutrition and who may benefit from nutrition support.     

慢性放射性肠损伤病人的围手术期营养支持

目的:探讨慢性放射性肠损伤(CRII)病人围手术期营养支持情况。方法:采用主观全面评价(SGA)系统回顾性总结206例CRII病人围手术期营养支持情况,并对CRII病人的营养状况进行评估。结果:206例CRII病人接受手术229例次,86.16%的病人入院时有营养不良。经围手术期营养支持和手术治疗后,病人的营养状况得到了明显改善,但营养不良发生率仍然较高。结论:CRII病人的营养不良发生率甚高,围手术期营养支持时间较长,围手术期营养支持和手术能明显改善病人的营养状况。     

A Comprehensive Nutrition‐Focused Quality Improvement Program Reduces 30‐Day Readmissions and Length of Stay in Hospitalized Patients

Background: Although screening patients for malnutrition risk on hospital admission is standard of care, nutrition shortfalls are undertreated. Nutrition interventions can improve outcomes. We tested effects of a nutrition‐focused quality improvement program (QIP) on hospital readmission and length of stay (LOS). Materials and Methods: QIP included malnutrition risk screening at admission, prompt initiation of oral nutrition supplements (ONS) for at‐risk patients, and nutrition support. A 2‐group, pre‐post design of malnourished adults with any diagnosis was conducted at 4 hospitals: QIP‐basic (QIPb) and QIP‐enhanced (QIPe). Comparator patients had a malnutrition diagnosis and ONS orders. For QIPb, nurses screened all patients on admission using an electronic medical record (EMR)–cued Malnutrition Screening Tool (MST); ONS was provided to patients with MST scores ≥2 within 24–48 hours. QIPe had ONS within 24 hours, postdischarge nutrition instructions, telephone calls, and ONS coupons. Primary outcome was 30‐day unplanned readmission. We used baseline (January 1–December 31, 2013) and validation cohorts (October 13, 2013–April 2, 2014) for comparison. Results: Patients (n = 1269) were enrolled in QIPb (n = 769) and QIPe (n = 500). Analysis included baseline (n = 4611) and validation (n = 1319) comparator patients. Compared with a 20% baseline readmission rate, post‐QIP relative reductions were 19.5% for all QIP, 18% for QIPb, and 22% for QIPe, respectively. Compared with a 22.1% validation readmission rate, relative reductions were 27.1%, 25.8%, and 29.4%, respectively. Similar reductions were noted for LOS. Conclusions: Thirty‐day readmissions and LOS were significantly lowered for malnourished inpatients by use of an EMR‐cued MST, prompt provision of ONS, patient/caregiver education, and sustained nutrition support.