Malnutrition is a debilitating and highly prevalent condition in the acute hospital setting, with Australian and international studies reporting rates of approximately 40%. Malnutrition is associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, longer lengths of hospital stay, higher treatment costs and increased mortality. Referral rates for dietetic assessment and treatment of malnourished patients have proven to be suboptimal, thereby increasing the likelihood of developing such aforementioned complications. Nutrition risk screening using a validated tool is a simple technique to rapidly identify patients at risk of malnutrition, and provides a basis for prompt dietetic referrals. In Australia, nutrition screening upon hospital admission is not mandatory, which is of concern knowing that malnutrition remains under-reported and often poorly documented. Unidentified malnutrition not only heightens the risk of adverse complications for patients, but can potentially result in foregone reimbursements to the hospital through casemix-based funding schemes. It is strongly recommended that mandatory nutrition screening be widely adopted in line with published best-practice guidelines to effectively target and reduce the incidence of hospital malnutrition.

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.

Preoperative immunonutrition therapy in gastrointestinal surgery has the potential to reduce the LOS and cost, with greater treatment benefit seen in malnourished patients; however, there is a need for additional research with greater patient numbers.

Aim To determine the safety, operational feasibility and environmental impact of collecting unopened non‐perishable packaged hospital food items for reuse. Methods This pilot study tested packaged foods from an Australian hospital for bacterial species, and compared this to acceptable safe limits. A waste management strategy was trialled (n = 10 days) where non‐perishable packaged foods returning to the hospital kitchen were collected off trays, and the time taken to do this and the number and weight of packaged foods collected was measured. Data were extrapolated to estimate the greenhouse gasses produced if they were disposed of in a landfill. Results Microbiological testing (n = 66 samples) found bacteria (total colony forming units and five common species) on packaging appeared to be within acceptable limits. It took an average of 5.1 ± 10.1 sec/tray to remove packaged food items from trays returning to the kitchen, and an average of 1768 ± 19 packaged food items were per collected per day, equating to 6613 ± 78 kg/year of waste which would produce 19 tonnes/year of greenhouse gasses in landfill. Conclusions A substantial volume of food items can be collected from trays without significantly disrupting current processes. Collecting and reusing or donating non‐perishable packaged food items that are served but not used within hospitals is a potential strategy to divert food waste from landfill. This pilot study provides initial data addressing infection control and feasibility concerns. While food packages in this hospital appear safe, further research with larger samples and testing additional microbial species is recommended.

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