clinical focus
that malnutrition in hospitals is associated
with prolonged hospital stay, greater
risk of readmission, slower recovery,
increased risk of pressure ulcers, decreased
functional capacity in patients, and a
greater risk of death. These outcomes not
only have a significant impact on patients
and their families, but they also have a big
impact on the healthcare system.
It’s been estimated that the cost of
treating a patient who has the risk of
malnutrition is at least 20 per cent higher
than treating someone who is well
nourished, in the hospital system. There
have been studies done in the UK that
estimate the cost of malnutrition there is
more than £13 billion, which is about $20
million Australian.
There have been a couple of good
studies done between 2002 and 2004.
One of them was done in 45 public
hospitals in Victoria, and they estimated
that the cost of malnutrition to public
hospitals in Victoria was over $10
million. Another study that was done
in Queensland based public hospitals
found that the cost of malnutrition related
pressure ulcers was over $13 million.
As I said before, these studies were
done at least 15 years ago, so one can
only imagine what the equivalent cost
estimates would be in the present age.
What should be done to address this
issue?
A starting point would be to acknowledge
and accept malnutrition as a formidable
problem. Malnutrition in hospitals has long
been known as a skeleton in the hospital’s
closet. It is time that we bring the skeleton
out of the closet, and out in the open. It
is time now for the focus of malnutrition
to shift from being within the dietitians’
domain, to extend beyond. Policymakers
and all healthcare professionals, whether
they are medical professionals, nursing
professionals, allied healthcare professionals
or food services staff in the hospital system,
should feel more responsible in terms of
managing malnutrition.
When we talk about stakeholders, we
also need to remember that patients
themselves are important stakeholders in
the management of malnutrition. There
is evidence to suggest that malnourished
patients don’t recognise that malnutrition
is a problem when they’re admitted in
hospital, which is a big issue. Patients
need to become aware of the perils of
malnutrition, because it is a big problem to
them, and it can affect their recovery.
There is a range of screening tools
that are evidence based. One of them
being a malnutrition screening tool which
is literally a two question tool which
anybody in hospital can administer. That
can determine whether or not a patient
is at risk of developing malnutrition. We
need to use that tool as part of day to day
good practice, because in summary, if
malnutrition is not recognised, it is unlikely
to be treated.
For healthcare professionals, I think
we need to adopt a collaborative,
multidisciplinary approach, in addressing
malnutrition as a problem. Because
malnutrition is everyone’s problem. ■
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