Evaluation of nutritional assessment quality and rate of referral to dietitian in Shariati hospital, Tehran-Iran: A clinical audit

  • Mohammadreza Emami
  • Meysam Zarezadeh Tehran University of Medical Sciences
  • Mohammad Sharifzadeh
  • Zahra Fazelifarsani
  • Masoud Khorshidi Mail
Clinical Audit, Nutrition assessment, Quality of health care, hospital practice


Background: Malnutrition is an acute or chronic nutri­tional status resulting from an imbalance in the intake that is associated with over-nutrition and inadequate in­take, leading to changes in the composition or reduced function of the body. Bio-social conditions, and acute and chronic diseases are the most important factors affecting nutrition and can cause malnutrition. It has suggested that awareness about the prevalence and severity of malnutrition in hos­pitalized patients can be used by managers to under­stand the causes, health care systems requirements and health plans.

Methods: Medical records of 483 patients from 11 different wards was assessed to evaluate the rate of nutritional assessment form fill out and referral to nutrition experts by physicians. This study consisted of two stages. Patients were evaluated in term of initial nutritional assessment and accuracy of malnutrition screening forms completion, respectively.

Results: Our study showed no initial nutritional assessment for 34% of the patient in the first phase. Assessment of the accuracy of malnutrition screening items completion showed that there is considerable error in report of BMI (66%), weight loss (51%), appetite loss (50%) and severity of patient’s situation (39%). Also, the rate of referral to nutritionist was zero and one percent in first and second phase of the study, respectively.

Conclusion: Present study showed that the rate of nutritional screening and subsequently referral to nutrition expert for professional nutritional assessment is negligible in Shariati hospital Tehran-Iran.


1. Soeters PB, Reijven PL, Schols JM, Halfens RJ, Meijers JM, van Gemert WG. A rational approach to nutritional assessment. Clinical Nutrition. 2008;27(5):706-16.
2. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clinical nutrition. 2003;22(4):415-21.
3. Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’(‘MUST’) for adults. British Journal of Nutrition. 2004;92(5):799-808.
4. Pirlich M, Schütz T, Kemps M, Luhman N, Minko N, Lübke HJ, et al. Social risk factors for hospital malnutrition. Nutrition. 2005;21(3):295-300.
5. McKee J. Protein-calorie malnutrition: The skeleton in the litigation closet. J. Legal Nurse Consult. 2006;17:12-6.
6. Ferguson M. Uncovering the skeleton in the hospital closet. What next?(Leading article). Australian Journal of Nutrition and Dietetics. 2001;58(2):83-5.
7. Pirlich M, Schütz T, Norman K, Gastell S, Lübke HJ, Bischoff SC, et al. The German hospital malnutrition study. Clinical nutrition. 2006;25(4):563-72.
8. Banks M, Ash S, Bauer J, Gaskill D. Prevalence of malnutrition in adults in Queensland public hospitals and residential aged care facilities. Nutrition & Dietetics. 2007;64(3):172-8.
9. Jebb SA. Incidence and recognition of malnutrition in hospital: JP McWhirter and CR Pennington BMJ 1994; 308: 945–948. Clinical Nutrition. 1994;13(4):267-8.
10. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. International journal of environmental research and public health. 2011;8(2):514-27.
11. Christensen KS, Gstundtner KM. Hospital-wide screening improves basis for nutrition intervention. Journal of the American Dietetic Association. 1985;85(6):704-6.
12. Somanchi M, Tao X, Mullin GE. The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition. Journal of Parenteral and Enteral Nutrition. 2011;35(2):209-16.
13. Dinmohammadi M, Purmemary M. Nutrition markers in under-hemodialysis patients in Zanjan Shahid Beheshti Hospital. 2002.
14. Hosseini S, Amirkalali B, Nayebi N, Heshmat R, Larijani B. Nutrition status of patients during hospitalization, Tehran, Iran. Nutrition in clinical practice. 2006;21(5):518-21.
15. Nozari B, Tabibi H, Mahdavi-Mazdeh M, Hedayati M, Houshiar Rad A. Prevalence of protein-energy malnutrition and its various types in hemodialysis patients in Tehran, 2008. Iranian Journal of Nutrition Sciences & Food Technology. 2010;5(1):17-28.
16. Ferguson M, Capra S. Nutrition screening practices in Australian hospitals. Australian journal of nutrition and dietetics. 1998.
17. Elia M, Zellipour L, Stratton RJ. To screen or not to screen for adult malnutrition? Clinical Nutrition. 2005;24(6):867-84.
18. Lazarus C, Hamlyn J. Prevalence and documentation of malnutrition in hospitals: a case study in a large private hospital setting. Nutrition & Dietetics. 2005;62(1):41-7.
19. Adams NE, Bowie AJ, Simmance N, Murray M, Crowe TC. Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients. Nutrition & Dietetics. 2008;65(2):144-50.
20. Kirkland LL, Kashiwagi DT, Brantley S, Scheurer D, Varkey P. Nutrition in the hospitalized patient. Journal of hospital medicine. 2013;8(1):52-8.
21. Singh H, Watt K, Veitch R, Cantor M, Duerksen DR. Malnutrition is prevalent in hospitalized medical patients: are housestaff identifying the malnourished patient? Nutrition. 2006;22(4):350-4.
22. Elia M. The'MUST'report. Nutritional screening for adults: a multidisciplinary responsibility. Development and use of the'Malnutrition Universal Screening Tool'(MUST) for adults: British Association for Parenteral and Enteral Nutrition (BAPEN); 2003.
23. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. Bmj. 1994;308(6934):945-8.
24. Kelly I, Tessier S, Cahill A, Morris S, Crumley A, McLaughlin D, et al. Still hungry in hospital: identifying malnutrition in acute hospital admissions. Qjm. 2000;93(2):93-8.
25. Edington J, Boorman J, Durrant E, Perkins A, Giffin C, James R, et al. Prevalence of malnutrition on admission to four hospitals in England. Clinical Nutrition. 2000;19(3):191-5.
26. Mowe M, Bøhmer T, Kindt E. Reduced nutritional status in an elderly population (> 70 y) is probable before disease and possibly contributes to the development of disease. The American journal of clinical nutrition. 1994;59(2):317-24.
27. Raja R, Lim A, Lim Y, Lim G, Chan S, Vu C. Malnutrition screening in hospitalised patients and its implication on reimbursement. Internal medicine journal. 2004;34(4):176-81.
28. Ferguson M, Capra S, Bauer J, Banks M. Coding for malnutrition enhances reimbursement under casemix-based funding. Australian journal of nutrition and dietetics. 1997.
29. Bruun L, Bosaeus I, Bergstad L, Nygaard K. Prevalence of malnutrition in surgical patients: evaluation of nutritional support and documentation. Clinical Nutrition. 1999;18(3):141-7.
30. ALLRED CRG, Voss AC, Finn SC, McCAMISH MA. Malnutrition and clinical outcomes: the case for medical nutrition therapy. Journal of the American Dietetic Association. 1996;96(4):361-9.
How to Cite
Emami M, Zarezadeh M, Sharifzadeh M, Fazelifarsani Z, Khorshidi M. Evaluation of nutritional assessment quality and rate of referral to dietitian in Shariati hospital, Tehran-Iran: A clinical audit. J Nutr Sci & Diet. 5(1).
Original Article(s)