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RESEARCH ARTICLE
Contents Vol 49(4)

The effect of dietitian universal nutrition assessment and malnutrition documentation on patient nutritional care and revenue in an acute care hospital

Gail Whitelock A B * and Michael Millward A
+ Author Affiliations
- Author Affiliations

A Cancer Program, Central Adelaide Local Health Network, SA, Australia.

B Department of Nutrition and Dietetics, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia.

* Correspondence to: gail.whitelock@sa.gov.au

Australian Health Review 49, AH25090 https://doi.org/10.1071/AH25090
Submitted: 23 April 2025  Accepted: 13 June 2025  Published: 3 July 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

This case study sought to determine if a dietitian universal nutrition assessment (DUNA) with initial nutrition care plan and high-quality documentation was a cost-effective way of delivering nutrition care within the cancer service of a tertiary hospital. A 2-week pilot project of universal nutrition assessment by dietitians for admitted patients demonstrated a high prevalence of cancer-related malnutrition (57%, n = 39). The episodes for malnourished patients not identified through usual referral processes (18%, n = 7) were examined to determine the National Weighted Activity Unit (NWAU) with and without the malnutrition diagnosis. The additional malnutrition diagnoses were responsible for an NWAU uplift of 8.1. A larger 10-month project was undertaken where patients underwent DUNA on admission with an initial nutrition care plan and high-quality documentation of malnutrition. Fifty-one percent of patients were malnourished with an increase in the number of coded malnutrition diagnoses as compared to baseline. Financial modelling from the pilot project indicated an NWAU uplift of 66.96. With a National Efficient Price (NEP) of AUD$6032 (2023/24), this equated to an uplift of AUD$403,902.72 in 10 months. Universal nutrition assessment and high-quality documentation of malnutrition by dietitians enabled a greater number of patients with cancer-related malnutrition to receive nutrition care while generating improved revenue through clinical coding complexity. This revenue was used to fund an additional dietitian position. Areas of high prevalence of malnutrition may be better served by DUNA rather than nutrition risk screening followed by dietetic referral for nutrition assessment.

Keywords: cancer, clinical coding, clinical documentation improvement, dietitian, malnutrition, nutrition, nutrition assessment, oncology.

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