Development and feasibility of a bedside decision support tool (DST) to identify and treat hospital acquired malnutrition

Ms Natalie Simmance1, Ms Allison Lauder2, Ms  Clara Newsome1, Ms Kathryn Pierce2

1St Vincent’s Hospital Melbourne, Fitzroy, Australia, 2Western Health, Footscray, Australia


Aim: Malnutrition is a common, but often overlooked condition in hospitalised patients, contributing to morbidity and mortality. Further deterioration of nutrition status is frequent, due to catabolic effects of acute inflammation and insufficient nutritional intake. This study aimed to develop and evaluate a multidisciplinary DST to guide treatment for patients at risk of nutritional decline.

Method: The DST was developed in a stepwise approach, underpinned by a literature review and informed by feedback from end-users. The feasibility of the DST was explored by conducting a pilot study in two hospitals across four acute inpatient wards. The DST was placed in the bedside chart of all inpatients on the study wards. Staff experience was evaluated via an anonymous survey.

Results: The DST comprised ‘traffic-light’ colours to stratify patient risk and actions for guiding nurse-led, dietitian-led and team-based nutrition care. Surveys from n=40 multidisciplinary staff were analysed. The survey measured perceived  presentation, content and usefulness of the DST using a 5-point Likert scale ranging from 1 (strongly agree) to 5 (strongly disagree). Mean item scores identified positive and negative aspects of the DST, with an average score of 2.1 (SD 0.8) across all items, indicating a favourable response.

Significance of the findings to allied health: Optimising the design of a bedside DST to support timely treatment for patient malnutrition warrants further study. Measuring the effectiveness of this DST to improve patient outcomes is underway.


Natalie is an Advanced Accredited Practicing Dietitians and is the Chief Dietitian at St Vincent’s Hospital, Melbourne.  Current research interests have focused on system level enhancements, including improving clinical governance, extending scope of practice and trialing multidisciplinary care models to optimize nutrition care for hospitalized patients.