Defining and quantifying preventable and non‐preventable hospital‐acquired malnutrition—A cohort study

Abstract

Aim To define and quantify hospital‐acquired malnutrition, including the concept of preventable and non‐preventable malnutrition; and identify the main causes of preventable malnutrition. Furthermore, demonstrate potential cost‐savings for a quaternary hospital in Sydney (Australia) if a theoretical model of preventable malnutrition was applied to the penalties associated with hospital‐acquired malnutrition, compared to the current government framework. Methods A retrospective audit was conducted on electronic medical records reassessing cases of hospital‐acquired malnutrition previously identified by dietitians or medical coders. Costs were calculated using the Independent Hospital Pricing Authority's (IHPA) pricing principles for hospital‐acquired complications (version 3, 2018). Results Twenty‐three patients of 15 419 admissions were identified with hospital‐acquired malnutrition in the 3‐month study period. Sixteen cases (70%) were classified as preventable, two cases (9%) were classified as non‐preventable, and five cases were non‐hospital‐acquired cases of malnutrition. Under the IHPA proposed costing model, total cost of all hospital‐acquired malnutrition to the hospital is estimated to be $162 600 over 3 months. The theoretical model of preventable malnutrition resulted in a cost penalty of only $98 600, which is a hospital cost‐saving of $64 000 (or 40% of the overall penalty) when compared to the current government framework. Conclusions The majority of hospital‐acquired malnutrition cases were found to have a preventable component. It is proposed that a costing model that penalises hospitals for only preventable hospital‐acquired malnutrition be considered, which would permit hospitals to focus on addressing preventable (and thus actionable) causes of hospital‐acquired malnutrition with not only potential health benefits to patients but cost‐savings to hospitals.

Estratégias gastronômicas para melhorar a aceitabilidade de dietas hospitalares: Uma breve revisão

“…A desnutrição, incluindo a desnutrição em ambientes hospitalares, continua a ser uma questão global (Syuhada et al, 2020). Na literatura, o termo desnutrição hospitalar tende a ser utilizado de forma semelhante ao termo desnutrição hospitalar adquirida (Cheng et al, 2019). A falta de critérios estabelecidos para o diagnóstico de desnutrição acrescenta mais complexidade à abordagem desta questão, uma vez que não é fácil definir com precisão a prevalência da desnutrição entre os pacientes no momento da admissão no hospital (Orlandoni et al, 2018).…”

“…Esse fato dificulta distinguir se a causa da desnutrição teve origem no hospital ou se o paciente já se encontrava desnutrido no momento da admissão (Cheng et al, 2019). A desnutrição observada em pacientes hospitalizados é frequentemente uma combinação de caquexia (relacionada com doenças) e má nutrição (consumo inadequado de nutrientes) (Barker, Gout & Crowe, 2011).…”

Dietary intake in health and disease, challenges in measuring and reporting diet‐disease relationships

“…Prevalence of the debilitating condition in an acute care setting has been documented between 20% and 50%, depending on the patient population and diagnosis criteria and is associated with adverse health outcomes including, increased length of stay and healthcare costs . This issue includes two studies by Cheng et al and Marderfeld et al, which explore timely and accurate malnutrition screening in acute care settings.…”

“…Cheng et al conducted a retrospective audit of electronic medical records to define and quantify hospital‐acquired malnutrition, including prevalence and causes of preventable vs non‐preventable malnutrition. While the majority of hospital‐acquired malnutrition cases included a preventable component, the authors propose an alternative costing model to the recent Independent Hospital Pricing Authority (IHPA) cost model.…”

Quality of nutritional care provided to patients who develop hospital acquired malnutrition: A study across five Australian public hospitals

“…Hospital acquired malnutrition (HAM) was officially recognised as a hospital‐acquired complication in Australia in July 2018, 1 with public hospitals incurring financial penalties for high rates of HAM 2 . HAM was recently described in an Australian study as any decline in nutritional status occurring in hospital, regardless of nutritional status on admission 3 . Across the state of Queensland, Australia, HAM has been defined as malnutrition first diagnosed > 14 days after hospital admission.…”