Malnutrition identification,diagnosis and dietetic referrals: Are we doing a good enough job?

Aim: To determine the prevalence and diagnosis, documentation and referral rates for malnutrition among hospitalised patients and to ascertain potential shortfalls in financial reimbursement to a hospital as a result of malnutrition misdiagnosis. Methods: The Subjective Global Assessment tool was used to assess the nutritional status of 275 randomly selected inpatients on admission over a five‐week period across the acute care wards of a metropolitan tertiary teaching hospital. A retrospective audit of malnourished patients' medical histories was performed to assess diagnosis, documentation and dietetic referral rates for malnutrition. Where malnutrition was not included in the coding of an admission, that admission was hypothetically recoded to determine whether it changed the Diagnosis Related Group and subsequently the payment allocated for that admission. Results: Prevalence of malnutrition was 23%. Malnourished patients had significantly longer lengths of stay by 4.5 days compared with well‐nourished patients (P < 0.001). Only 15% of malnourished patients were correctly identified and documented as such in the medical histories. A dietitian was involved in 45% of malnutrition cases, but only documented 29% of such cases as malnourished. Forty‐eight of 53 (91%) audited cases did not have the corresponding malnutrition code included in their Diagnosis Related Group, resulting in a shortfall of AU$27 617 to the hospital in reimbursements, and AU$1 850 540 when extrapolated across the financial year. Conclusion: Malnutrition is highly prevalent in the acute hospital setting, yet remains poorly identified and formally documented. Many patients are not referred for dietetic intervention, thus compromising their clinical outcomes. Poor documentation of malnutrition can further result in financial shortfalls to the hospital.