BackgroundThe present study aimed to determine the eHealth readiness and changes over time of dietitians in Australia. MethodsTwo cross-sectional analyses of Australian dietitians were conducted in 2013 and 2016, using a survey adapted from one conducted in 2011 by the US Academy of Nutrition and Dietetics. The survey encompassed 30 questions on eHealth readiness across five dimensions: access, standards, attitude, aptitude and advocacy. Descriptive statistics, independent t-tests, chi-squared tests and Z-tests were computed to compare responses from the 2013 and 2016 surveys. ResultsThe survey completion rate represented 14.5% (747) of the Dietitians Association of Australia members in 2013 and 8% (417) in 2016. The survey responses in relation to access and standards suggest that dietitians are well positioned for eHealth. For attitude and aptitude, there is a moderate level of preparedness, with minor improvements over time. Although showing significant improvement (P < 0.05), advocacy highlights the area requiring the most development because the majority of dietitians (61%) reported no role' in eHealth solutions. ConclusionsDietitians are progressing in relation to access, attitudinal and aptitudinal readiness for eHealth, although they rate poorly with respect to advocacy readiness. It was concluded that dietitians are not yet ready, and also that valuable opportunities to achieve the benefits that eHealth can deliver will be missed, if dietitians do not take the lead in guiding the development, selection and implementation of nutrition-related technologies. Strengthening the dimension of advocacy and ensuring collaboration across the profession, drawing on the varying expertise demonstrated across the practice areas and by the different generations, will be central to improving dietitian eHealth readiness.

AIM:To develop a framework for assessing the eHealth readiness of dietitians.METHODS:Using an inductive approach, this research was divided into three stages: 1. a systematic literature review to identify models or frameworks on eHealth readiness; 2. data synthesis to identify eHealth readiness themes and develop a framework; and 3. semi-structured interviews with Australian nutrition informatics experts to gain consensus and validate the framework.RESULTS:Two hundred and forty one unique citations were identified, of which twenty four met the research criteria and were included in the review and subsequent synthesis. Common eHealth readiness themes or dimensions were extracted from the literature, and five key dimensions were identified that were relevant to dietitian eHealth readiness: access, standards, attitude, aptitude and advocacy. A framework diagram was designed and discussed during semi-structured interviews with ten nutrition informatics experts to inform the final framework. The result of this research was an inductively developed Framework for eHealth Readiness of Dietitians (FeRD).DISCUSSION:The FeRD builds on existing theories and models, and provides a conceptual model for developing eHealth readiness evaluation tools to examine, measure and drive strategies to better prepare dietitian professionals for eHealth.

Background & aims: Obesity, defined as a BMI >= 30 kg/m(2), has demonstrated protective associations with mortality in some diseases. However, recent evidence demonstrates that poor nutritional status in critically ill obese patients confounds this relationship. The purpose of this paper is to evaluate if poor nutritional status, poor food intake and adverse health-related outcomes have a demonstrated association in non-critically ill obese acute care hospital patients. Methods: This is a secondary analysis of the Australasian Nutrition Care Day Survey dataset (N = 3122), a prospective cohort study conducted in hospitals from Australia and New Zealand in 2010. At baseline, hospital dietitians recorded participants' BMI, evaluated nutritional status using Subjective Global Assessment (SGA), and recorded 24-h food intake (as 0%, 25%, 50%, 75%, and 100% of the offered food). Post-three months, participants' length of stay (LOS), readmissions, and in-hospital mortality data were collected. Bivariate and regression analyses were conducted to investigate if there were an association between BMI, nutritional status, poor food intake, and health-related outcomes. Results: Of the 3122 participants, 2889 (93%) had eligible data. Obesity was prevalent in 26% of the cohort (n = 750; 75% females; 61 +/- 15 years; 37 +/- 7 kg/m(2)). Fourteen percent (n = 105) of the obese patients were malnourished. Over a quarter of the malnourished obese patients (N = 30/105, 28%) consumed <25% of the offered meals. Most malnourished obese patients (74/105, 70%) received standard diets without additional nutritional support. After controlling for confounders (age, disease type and severity), malnutrition and intake <= 25% of the offered meals independently trebled the odds of in hospital mortality within 90 days of hospital admission in obese patients. Conclusion: Although malnourished obese experienced significantly adverse health-related outcomes they were least likely to receive additional nutritional support. This study demonstrates that BMI alone cannot be used as a surrogate measure for nutritional status and warrants routine nutritional screening for all hospital patients, and subsequent nutritional assessment and support for malnourished patients. Crown Copyright (C) 2018 Published by Elsevier Ltd. All rights reserved.

Aim To explore dietitians' perspectives on the eHealth readiness of Australian dietitians, and to identify strategies to improve eHealth readiness of the profession. Methods Dietitians who met the criteria for nutrition informatics experts participated in semi-structured interviews between June 2016 and March 2017. The interviews were recorded and transcribed verbatim. Thematic analysis using coding was undertaken until consensus was reached by the researchers regarding key themes, topics and exemplar quotes. Results Interviews with 10 nutrition informatics experts revealed 25 discussion topics grouped into four main themes: benefits of eHealth for dietitians; risks of dietitians not being involved in eHealth; dietitians are not ready for eHealth; and strategies to improve eHealth readiness. The strategies identified for improving eHealth readiness included: collaboration and representation, education, offering of incentives and mentoring, as well as development of a national strategy, organisational leaders, nutrition informatics champions and a supportive environment. Conclusions These findings suggest that dietitians may not be ready for eHealth. Strategic leadership and the actioning of other identified strategies will be imperative to preparing dietitians for eHealth to ensure the profession can practice effectively in the digital age, optimise nutrition care and support research for eHealth. If dietitians do not engage in eHealth, others may take their place, or dietitians may be forced to use eHealth in ways that are not the most effective for practice or maximising patient outcomes.

Background Malnutrition is common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to explore its association with all-cause mortality, emergency hospitalisation and subsequently healthcare costs. Methods A prospective cohort observational pilot study was carried out in outpatients with COPD that attended routine respiratory clinics at a large tertiary Australian hospital during 2011. Electronic hospital records and hospital coding was used to determine nutritional status and whether a patient was coded as nourished or malnourished and information on healthcare use and 1-year mortality was recorded. Results Eight hundred and thirty four patients with COPD attended clinics during 2011, of those 286 went on to be hospitalised during the 12 month follow-up period. Malnourished patients had a significantly higher 1-year mortality (27.7% vs. 12.1%; p = 0.001) and were hospitalised more frequently (1.11 SD 1.24 vs. 1.51 SD 1.43; p = 0.051). Only malnutrition (OR 0.36 95% CI 0.14–0.91; p = 0.032) and emergency hospitalisation rate (OR 1.58 95% CI 1.2–2.1; p = 0.001) were independently associated with 1-year mortality. Length of hospital stay was almost twice the duration in those coded for malnutrition (11.57 SD 10.93 days vs. 6.67 SD 10.2 days; p = 0.003) and at almost double the cost (AUD $23,652 SD $26,472 vs. $12,362 SD $21,865; p = 0.002) than those who were well-nourished. Conclusion Malnutrition is an independent predictor of 1-year mortality and healthcare use in patients with COPD. Malnourished patients with COPD present both an economic and operational burden.

BACKGROUNDOptimal results from bariatric surgery are contingent on patient commitment to dietary and lifestyle changes and follow-up care. The present study aimed to investigate the attitudes and use of mobile health (mHealth) smartphone applications (apps) as a potential tool for maintaining connectivity between dietitians and patients post-bariatric surgery.METHODSA cross-sectional online survey was developed and distributed to a purposeful sample of bariatric dietitians and bariatric patients in Australia. The survey questions explored technology penetration (smartphone and app use), communication preferences, nutrition monitoring methods, professional relationship expectations and reasons for loss to follow-up.RESULTSSurvey completion rate was 85% (n = 50/59) for dietitians and 80% (n = 39/49) for patients. Smartphone ownership was 98% and 95% for dietitians and patients, respectively. Common reasons given for losing patients to follow-up suggest that a traditional in-clinic practice setting could be a barrier for some. Most dietitians (n = 48; 91%) prefer to see patients face-to-face in their clinic, whereas patient preferences extended to e-mail and mobile messaging. Sixty-eight percent of bariatric patients were receptive to two-way communication with dietitians via an app between clinic visits. Both cohorts recognised the potential for emerging technologies to be used in practice, although there was no single routinely recommended mHealth app.CONCLUSIONSThe present study provides the first insight into the use of mobile devices and apps by post-bariatric patients and the dietitians who support them. A mixture of traditional methods and smartphone technology is desirable to both dietitians and patients. The utility and effectiveness of such technologies should be confirmed in future intervention studies.

AimTo explore malnutrition screening practices by dietitians working with community dwelling older adults in Australia.MethodsA descriptive cross‐sectional online survey of dietitians providing dietetic care to older adults (aged ≥65 years) was conducted in November to December 2014 using a three‐part 25‐item questionnaire with scaled, closed and open‐ended questions.ResultsOne hundred and thirty‐three community dietitians participated in the survey. Seventy‐seven percent of them reported malnutrition screening was conducted in the workplace and this was highest in government organisations. The majority of dietitians (75%) reported a screening tool was used and the Malnutrition Screening Tool was most commonly used. Independent of level of experience, the majority of dietitians considered malnutrition screening important and agreed with the need for routine screening. Sixty‐six percent of dietitians reported that clients screened and found to be at risk of malnutrition frequently refused nutrition assessment.ConclusionReported malnutrition screening practices varied considerably across all organisations and states. Although routine screening for malnutrition risk is recommended, refusal for nutritional assessment after positive screening is common and requires further investigation. It is not clear how the term ‘malnutrition’ is perceived by the elderly and further investigation into their perceptions would be useful, particularly as offer for nutrition care is frequently declined.

57 Background and Aims: One aim of the Australasian Nutrition Care Day Survey was to 58 determine the nutritional status and dietary intake of acute care hospital patients. 59 Methods: Dietitians from 56 hospitals in Australia and New Zealand completed a 24-hour 60 survey of nutritional status and dietary intake of adult hospitalised patients. Nutritional risk 61 was evaluated using the Malnutrition Screening Tool. Participants ‘at risk’ underwent 62 nutritional assessment using Subjective Global Assessment. Based on the International 63 Classification of Diseases (Australian modification), participants were also deemed 64 malnourished if their body mass index was < 18.5 kg/m. Dietitians recorded participants’ 65 dietary intake at each main meal and snacks as 0%, 25%, 50%, 75%, or 100% of that 66 offered. 67 Results: 3122 patients (mean age: 64.6 ± 18 years) participated in the study. Forty-one 68 percent of the participants were “at risk” of malnutrition. Overall malnutrition prevalence was 69 32%. Fifty-five percent of malnourished participants and 35% of well-nourished participants 70 consumed ≤ 50% of the food during the 24-hour audit. “Not hungry” was the most common 71 reason for not consuming everything offered during the audit. 72 Conclusion: Malnutrition and sub-optimal food intake is prevalent in acute care patients 73 across hospitals in Australia and New Zealand and warrants appropriate interventions. 74 75 (199 words) 76 77

AimPersonality traits refer to habitual patterns of behaviour, thoughts and emotions, and have been shown to influence health professionals' career pathways. The present study explored the associations between dietitians' personality profiles and the areas of dietetic practice they have previously worked.MethodsSurvey of 346 dietitians; 95% female; aged 32 10 years; median 7 years (range 0-35) since graduation. Personality traits were investigated using the Temperament and Character Inventory, and cluster analysis was used to group participants into three clusters, known as Profiles, based upon common combinations of personality trait levels. Relationships between personality clusters and areas of dietetic practice were investigated using univariate and multivariate analyses.ResultsCompared with other participants, dietitians in Profile A displayed moderate levels of Harm Avoidance, Persistence and Self-Directedness; dietitians in Profile B displayed higher levels of Persistence and Self-Directedness, and lower levels of Harm Avoidance; and dietitians in Profile C displayed higher levels of Harm Avoidance and lower levels of Persistence and Self-Directedness. Dietitians in Profile A were twice as likely to have worked in Private Practice/Consultancy compared with Profile C (OR = 1.90, 95% CI: 1.07-3.38, P < 0.05), and dietitians in Profile B were over four times more likely to have worked in Food Service Management compared with Profile C (OR = 4.35, 95% CI: 1.47-12.84, P < 0.01).ConclusionsDietitians' personality may influence their decision to work in some areas of dietetic practice. Employees and employers should be mindful of personal traits when making employment decisions because some environments may be more conducive to specific attributes of dietitians to facilitate competent performance in a role.

Background Inadequate dietary intake is a common problem amongst older acute-care patients and has been identified as an independent risk factor for in-hospital mortality. This study aimed to explore whether food and mealtime experiences contribute to inadequate dietary intake in older people during hospitalisation. Methods This was a qualitative phenomenological study, data for which were collected using semi-structured interviews over a three-week period. During this time, 26 patients aged 65 years or more, admitted to medical and surgical wards in a tertiary acute-care hospital, were asked to participate if they were observed to eat less than half of the meal offered at lunch. Participants provided their perspectives on food and mealtimes in hospital. Responses were recorded as hand-written notes, which were agreed with the interviewee, and analysed thematically using the framework method. Results Twenty-five older people were interviewed across six wards. Two main themes, ‘validating circumstances’ and ‘hospital systems’, were identified. Each theme had several sub-themes. The sub-themes within validating circumstances included ‘expectations in hospital’, ‘prioritising medical treatment’, ‘being inactive’, and ‘feeling down’. Those within ‘hospital systems’ were ‘accommodating inconvenience’, ‘inflexible systems’, and ‘motivating encouragement’. Conclusion Inadequate dietary intake by older hospital patients is complex and influenced by a range of barriers. Multilevel and multidisciplinary interventions based on a shared understanding of food and nutrition as an important component of hospital care are essential to improve dietary intake and reduce the risk of adverse clinical outcomes. Improving awareness of the importance of food for recovery amongst hospitalised older people and healthcare staff is a priority.

To achieve a consistent and accurate definition and diagnosis of malnutrition, the Academy of Nutrition and Dietetics (Academy) collaborated with the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) to develop clinical characteristics of malnutrition 1 White J.V. Guenter P. Jensen G. et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet. 2012; 112: 730-738 Abstract Full Text Full Text PDF PubMed Scopus (425) Google Scholar , 2 White J.V. Guenter P. Jensen G. et al. Consensus statement: Academy of Nutrition and Dietetics and American society for Parenteral and Enteral Nutrition: Characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr. 2012; 36: 275-283 Crossref PubMed Scopus (711) Google Scholar : weight loss over time, inadequate energy intake compared with estimated needs, muscle loss, fat loss, fluid accumulation, and diminished grip strength. These characteristics were intended to distinguish between severe and nonsevere malnutrition for adults in all settings. 1 White J.V. Guenter P. Jensen G. et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet. 2012; 112: 730-738 Abstract Full Text Full Text PDF PubMed Scopus (425) Google Scholar The clinical characteristics draw upon earlier work that recommended identifying acute or chronic disease/inflammation and social and environment-related circumstances as malnutrition etiologies. 3 Jensen G.L. Mirtallo J. Compher C. et al. Adult starvation and disease-related malnutrition: A proposal for etiology-based diagnosis in the clinical practice setting from the international consensus guideline committee. JPEN J Parenter Enteral Nutr. 2010; 34: 156-159 Crossref PubMed Scopus (347) Google Scholar While the malnutrition clinical characteristics (MCCs) were developed and published jointly by the Academy and A.S.P.E.N., both groups recognized that the body of evidence supporting the clinical characteristics was limited, and recommended that they be validated. R. K. Hand is director, Dietetics Practice Based Research Network, Academy of Nutrition and Dietetics, Chicago, IL. W. J. Murphy is a senior manager, Outcomes Research, Academy of Nutrition and Dietetics, Chicago, IL. A. L. Steiber is chief science officer, Academy of Nutrition and Dietetics, Chicago, IL. L. B. Field is an independent nutrition consultant in Emmitsburg, MD; at the time of the study, she was the Abbott Nutrition Malnutrition Research Fellow at the Academy of Nutrition and Dietetics, Chicago, IL. J. A. Lee is vice president and director, Systems Research and Initiatives, Altarum Institute, Ann Arbor, MI. J. S. Parrott is an associate professor, Department of Interdisciplinary Studies, School of Health Related Professions, Rutgers University, Newark, NJ. M. Ferguson is director, Dietitian Connection, Queensland, Australia. A. Skipper is with the American Medical Association, Chicago, IL. ErratumJournal of the Academy of Nutrition and DieteticsVol. 117Issue 6PreviewIn the article “Validation of the Academy/A.S.P.E.N. Malnutrition Clinical Characteristics” published in the May 2016 issue of the Journal of the Academy of Nutrition and Dietetics on pp 856-864, part of the article title was mistakenly omitted. The full title of the article should read: “Validation of the Academy/A.S.P.E.N. Malnutrition Clinical Characteristics: Methodology and Results of a Pilot Study”. Full-Text PDF

Aim: The International Classification of Diseases, version 10, Australian modification (ICD-10-AM) is used to classify diseases in hospital patients in Australia and New Zealand. ICD-10-AM defines malnutrition as '[body mass index] BMI <18.5 kg/m(2) or unintentional weight loss of >= 5% with evidence of suboptimal intake resulting in subcutaneous fat loss and/or muscle wasting'. The Australasian Nutrition Care Day Survey (ANCDS) is the most comprehensive survey to evaluate malnutrition prevalence in acute care patients from Australian and New Zealand hospitals. This study determined if malnourished participants were assigned malnutrition-related codes according to ICD-10-AM.Methods: The ANCDS recruited acute care patients from 56 hospitals. Hospital-based dietitians evaluated participants' nutritional status using BMI and Subjective Global Assessment (SGA). In keeping with the ICD-10-AM definition, malnutrition was defined as BMI <18.5 kg/m(2), SGA-B (moderately malnourished) or SGA-C (severely malnourished). After 3 months, in this prospective cohort study, staff members from each hospital's health information/medical records department provided coding results for malnourished participants.Results: Malnutrition was prevalent in 30% (n = 869) of the cohort (n = 2976) and a significantly small number of malnourished patients were coded for malnutrition (n = 162, 19%, P < 0.001). In 21 hospitals, none of the malnourished participants were coded.Conclusions: This is the largest study to provide a snapshot of malnutrition coding in Australian and New Zealand hospitals. Findings highlight gaps in malnutrition documentation and/or subsequent coding, which could potentially result in significant loss of casemix-related revenue for hospitals. Dietitians must lead the way in developing structured processes for malnutrition identification, documentation and coding.

Aim: To determine the method and extent of health information technology (HIT) utilisation, roles in relation to HIT in the workplace and perceived barriers and benefits of HIT by dietitians in Australia and provide a comparison with dietitians in the USA. Methods: A survey adapted from the 2011 Academy of Nutrition and Dietetics (Academy) was utilised and circulated electronically to Dietitians Association of Australia members and advertised through a professional nutrition website in 2013. The survey encompassed 25 questions on computer access and use, data sources, experience using HIT, organisational involvement and perceived barriers and benefits to HIT. Descriptive statistics, independent t-tests, chi-square tests and z-tests were computed to investigate and compare responses from the 2013 Australian and 2011 Academy surveys. Results: The survey completion rate represented 14.5% of Dietitians Association of Australia members (747) and 5% of Academy members (3342). The Australian and Academy respondents reported similar high levels of comfort using technology, awareness of workplace HIT benefits (such as enhanced time management and improved ability to access data) and low levels of organisational involvement. However, there were a significantly greater number of Academy organisations utilising electronic health records (P < 0.05), and significantly more Academy respondents (55%) reported 'no barriers' to using HIT compared with Australians (37%) (P < 0.05). Conclusions: Educational programmes will be central to ensuring dietitians are equipped with technology and information management skills required to be involved in and make informed decisions about dietetic-related HIT projects as these will soon be fundamental to dietetic practice.

Objective: Phosphorus-based food additives may pose a significant risk in chronic kidney disease given the link between hyperphosphatemia and cardiovascular disease. The objective of the study was to determine the prevalence of phosphorus-based food additives in best-selling processed grocery products and to establish how they were reported on food labels.Design: A data set of 3000 best-selling grocery items in Australia across 15 food and beverage categories was obtained for the 12 months ending December 2013 produced by the Nielsen Company's Homescan database. The nutrition labels of the products were reviewed in store for phosphorus additives. The type of additive, total number of additives, and method of reporting (written out in words or as an E number) were recorded.Main Outcome Measures: Presence of phosphorus-based food additives, number of phosphorus-based food additives per product, and the reporting method of additives on product ingredient lists.Results: Phosphorus-based additives were identified in 44% of food and beverages reviewed. Additives were particularly common in the categories of small goods (96%), bakery goods (93%), frozen meals (75%), prepared foods (70%), and biscuits (65%). A total of 19 different phosphorus additives were identified across the reviewed products. From the items containing phosphorus additives, there was a median (minimum-maximum) of 2 (1-7) additives per product. Additives by E number (81%) was the most common method of reporting.Conclusion: Phosphorus-based food additives are common in the Australian food supply. This suggests that prioritizing phosphorus additive education may be an important strategy in the dietary management of hyperphosphatemia. Further research to establish a database of food items containing phosphorus-based additives is warranted. (C) 2015 by the National Kidney Foundation, Inc. All rights reserved.

AimInformation on attitudes and knowledge of practising dietitians regarding the Nutrition Care Process (NCP) and International Dietetics and Nutrition Terminology (IDNT) would be useful to inform effective implementation. The present study aimed to: (i) explore dietitians' expectations, perceptions and anticipated benefits of NCP/IDNT pre and post implementation; (ii) identify perceived implementation barriers and enablers; and (iii) develop and assess a train-the-trainer NCP/IDNT implementation approach.MethodsAll Queensland Government State hospitals from metropolitan, regional and remote areas were included in the study. Dietitian champions (n = 17) attended one face-to-face, train-the-trainer day, then led 14 one-hour educational sessions to 279 district dietitians tailored to local situations, facilities and resources. NCP/IDNT were embedded into local processes and chart audits completed. Pre-/post-implementation surveys were completed by 86 dietitians.ResultsPre-implementation results showed positive attitudes regarding the value of NCP/IDNT (mean 1.89, SD 0.67, 1 = strongly agree, 5 = strongly disagree). Dietitians identified management support; practice, tutorials and workshops; mentor support; and follow up audits as important for successful implementation. Most attendees (81%) completed 10/13 tutorials and 86% (415/480) of audited charts included Nutritional Diagnosis statements. Post-implementation familiarity, confidence and knowledge of NCPT (Nutrition Care Process Terminology) significantly improved (P < 0.001).ConclusionsPrior to implementation, respondents viewed the NCP/IDNT as applicable to their practice areas. The train-the-trainer program with frequent teleconference and email support was effective in improving knowledge, confidence, preparedness for implementing NCPT and charting behaviour. Although training was positively received and has achieved good results, dietitians identified the need for ongoing training and support to further increase confidence following implementation.

Background: Insightful accounts of patient experience within a health care system can be valuable for facilitating improvements in service delivery.Objective: The aim of this study was to explore patients' perceptions and experiences regarding a tertiary hospital Diabetes and Endocrinology outpatient service for the management of type 2 diabetes mellitus (T2DM).Method: Nine patients participated in discovery interviews with an independent trained facilitator. Patients' stories were synthesized thematically using a constant comparative approach.Results: Three major themes were identified from the patients' stories: 1) understanding T2DM and diabetes management with subthemes highlighting that specialist care is highly valued by patients who experience a significant burden of diabetes on daily life and who may have low health literacy and low self confidence; 2) relationships with practitioners were viewed critical and perceived lack of empathy impacted the effectiveness of care; and 3) impact of health care systems on service delivery with lack of continuity of care relating to the tertiary hospital model and limitations with appointment bookings negatively impacting on patient experience.Discussion: The patients' stories suggest that the expectation of establishing a productive, ongoing relationship with practitioners is highly valued. Tertiary clinics for T2DM are well placed to incorporate novel technological approaches for monitoring and follow-up, which may overcome many of the perceived barriers of traditional service delivery.Conclusion: Investing in strategies that promote patient-practitioner relationships may enhance effectiveness of treatment for T2DM by meeting patient expectations of personalized care. Future changes in service delivery would benefit from incorporating patients as key stakeholders in service evaluation.

Objective To trial malnutrition screening in older adults presenting to an emergency department (ED) and compare two service delivery models of nutritional support on nutritional status, quality of life, falls and unplanned hospital admissions. Design Participants (>60 years) presenting to ED screened at malnutrition risk were randomly allocated to either the control group (receiving regular treatment from community hospital interface programme nursing staff) or intervention group (receiving dietetic assessment, nutrition intervention and follow-up in addition to regular community hospital interface programme support). Outcome measures including body weight, quality of life, depression, falls history and days of hospital admissions were collected at baseline and 12 weeks. Results Of 703 patients screened, 84 (12%) were identified at malnutrition risk. 24 consented to the intervention study, with 88% (21/24) confirmed to be malnourished. Clinically important but not statistically significant differences were found over the 12-week trial; the intervention group (n=9) gained 0.8 kg (±3.7) while the control group (n=10) lost −1.1 kg (±4.6). The intervention group also had better quality of life, less depression and shorter hospital admissions. Conclusions Malnutrition screening appears feasible in ED. This pilot suggests a model of care providing nutrition support to older adults identified at nutritional risk may lead to improved patient outcomes but further research in a larger sample is required to confirm these findings.

Up to 30% of acute care patients consume less than half of the food provided in hospital. Inadequate dietary intake can have adverse clinical outcomes, including a higher risk of in-hospital mortality. This study aimed to investigate the reasons for poor intake among acute care patients in hospital. Patients with an observed intake of ≤50% of the food provided at lunch were approached to participate in the study. Thirty-two patients participated in semi-structured interviews over a three week period, to provide their perspective of food and mealtimes in hospital and discuss the reasons and factors influencing inadequate intake. Responses were coded and analysed thematically using the framework method. Patients reported both individual and organisational factors contribute to their inadequate intake. Half the patients reported the size of the meals were too large, with some patients reporting that large meal sizes puts them off their food and reduced their intake. ‘Not important to eat all the food provided’, and ‘do not need to eat much food in hospital’ were common attitudes among the patients. Half the patients reported that nurses did not observe their intake and were not concerned if all the food was not eaten. Identifying the reasons for poor intake can assist with the development of suitable interventions to improve dietary intake and reduce the risk of adverse clinical outcomes. Further investigation of suitable interventions to reduce portion sizes and improve both staff and patient perceptions of the importance of food in hospital is recommended.