Inadequate nutritional care for malnourished patients in four university hospitals – The QuaNuT study

Abstract

Background & Aims Adequate nutritional care to malnourished patients is described as a human right, and recommendations from nutritional care guidelines are legally binding in Norway. The primary objective of this study was to investigate nutritional care in malnourished hospitalized patients. We also wanted to describe the association between malnutrition and length of stay (LOS), readmission, comorbidity and mortality. Methods In a cross-sectional, multi-center and quality assurance study, inpatients from four university hospitals across all regional health authorities in Norway were included. The hospital's nutritional care during admission was evaluated according to current malnutrition guidelines. Malnutrition risk screening, assessment for diagnosis and grading severity of malnutrition were performed with Nutritional risk screening 2002 (NRS-2002) and the Global Leadership Initiative on malnutrition (GLIM) criteria. Medical records were reviewed to collect data on nutritional support during admission, malnutrition coding, LOS, readmission, comorbidity and 30-days survival after hospital admission. Results In our mixed inpatient population (n 442, mean age 61 years, 53 % women), 42 % were not adequately screened for risk of malnutrition at hospital admission. Among the 29 % of malnourished patients, only 36 % had documented nutritional support in the medical records, and a malnutrition diagnosis was registered for only 30 %. Malnutrition was associated with LOS, increased comorbidity and reduced 30-day survival. Conclusion In this study across all Norwegian regional health authorities, we found a high malnutrition rate and the nutritional care in relation to malnutrition diverged from national and international established guidelines and the framework of national laws and legislation. The findings raise concerns regarding patient safety and potential for improved nutritional care as a human right. Although malnutrition was associated with longer length of hospital stay, comorbidity and reduced 30-day survival, this study does not establish causal relationships.