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.