Academic journal article Australian Health Review

Malnutrition Prevalence in a Medical Assessment and Planning Unit and Its Association with Hospital Readmission

Academic journal article Australian Health Review

Malnutrition Prevalence in a Medical Assessment and Planning Unit and Its Association with Hospital Readmission

Article excerpt

Introduction

Malnutrition in hospitalised patients was identified as a significant issue more than a quarter of a century ago.1 Since then, numerous studies investigating malnutrition prevalence and its consequences have been published.2-7 Internationally, studies report a malnutrition prevalence ranging from 13 to 78% in acute hospital settings.3-6,8 In Australia, the prevalence of malnutrition in hospitals is estimated to be between 30 and 53%, depending on the different patient populations, settings and definitions of malnutrition used.3-5,7,9-11 The even further increased prevalence of malnutrition among older people5,12-14 is of additional concern given Australia's ageing population.4,9

A review of the published literature reveals that malnutrition rates have not improved over the last 15 years, indicating a continuous health problem among acute care patients.6,8,12 Many studies have demonstrated the importance of identifying malnutrition, with consequences including increased morbidity, mortality, length of hospital stay, readmission and healthcare costs.8,11,12,15,16 Malnutrition screening is strongly advocated as the first step to routinely identify nutritional problems early in both acute care and hospital-based ambulatory care settings.11,12,14,17-19 Rapid and accurate screening identifies those requiring more comprehensive nutrition assessment, and determines the need for nutritional interventions to achieve improved health outcomes.20,21 Several validated screening tools have been recommended for use in hospital populations,12,17,20,22 including the Malnutrition Screening Tool (MST),19 which is both valid and reliable for identifying nutrition problems in the acute care and hospital-based settings.21,22

Patient numbers presenting to hospital emergency departments (ED) has increased over the last decade, resulting in overcrowding, inefficiencies in service delivery, increased waiting times and length of stay, increased readmission and ultimately increased mortality.23-25 Consequently, Australian hospitals require new models of care to avoid unnecessary inpatient admissions, reduce length of stay and discharge patients to the most suitable post-acute care setting.23,26-28

Acute medical units (AMU) are designated hospital wards, specifically staffed and equipped to receive medical inpatients after presenting to ED, for assessment, care and treatment for a designated period, usually 36-48 h.25,27 Many hospitals have established AMU, with several synonyms used, including acute assessment units (AAU) and medical assessment and planning units (MAPU). AAU and MAPU have different philosophies behind their models of care, withAAUaiming to triage patients to the most appropriate ward for their medical condition, whereas MAPU aim to discharge patients home if appropriate.25-27 Both units involve thorough assessment by an extended health team to streamline the care process and determine the most appropriate final destination (e.g. home, care or rehabilitation service). The team approach addresses the needs of those with complex chronic medical and psychosocial conditions, in order to recognise and reduce functional decline, length of stay and avoidable acute care readmission.27

Early identification and assessment of preventable conditions such as malnutrition is important to enable the goal of the acute short stay unit (<48 h) to be achieved. To date only one known Australian study has documented the prevalence of malnutrition in an AMU setting and this study was conducted in an AAU, estimating a prevalence of 53%.10 There is no published literature exploring malnutrition in a MAPU operating with the model of care such as in the present study, i.e. with a model of care aiming to discharge patients home. Furthermore, no studies have considered the association between malnutrition and risk of hospital readmission in MAPU settings. The study aim was therefore to investigate: (i) the prevalence of malnutrition; (ii) the association of nutritional status on admission to MAPU with hospital readmission at 90 days; and (iii) assess the prevalence and agreement of malnutrition risk as indicated by the MST against the Subjective Global Assessment (SGA), chosen as the means for defining malnutrition. …

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