Clinical Dietitians' Perspectives on Nutrition Care Discharge Practices for Older Adults With Malnutrition: Insights From a Qualitative Exploratory Study.

Abstract

Background: Nutrition care continuity after hospital discharge is critical for supporting recovery in older adults with malnutrition, yet evidence suggests significant variability in nutrition care discharge practices. This study explored clinical dietitians' experiences, perspectives, and approaches to nutrition care discharge practices for older adults with malnutrition transitioning home from hospital.

Methods: Semi-structured interviews were conducted with clinical dietitians from two public hospitals in one health service in Queensland, Australia. Interviews, informed by the Theoretical Domains Framework and a recent chart audit conducted at the health service, explored current practices and factors influencing nutrition care continuity. Data were analysed using inductive thematic analysis following Braun & Clarke's six-step framework.

Results: Ten clinical dietitians were interviewed. Participants acknowledged the practice gaps identified in the chart audit were reflective of their current practice environment. Four core elements characterising nutrition care discharge practices were identified: dietitians positioned themselves as advocates for nutrition care continuity; practice evolved through clinical experience rather than formal guidance; comprehensive discharge planning was selectively implemented; and documentation and communication approaches varied. Factors influencing practice operated at individual (patient engagement, dietitian capabilities), process (workflow complexities, service coordination), and system levels (healthcare environment and structure, resource constraints and organisational culture).

Conclusions: Variability in nutrition care discharge practices reflects the interplay between system constraints, workflow challenges and dietitian adaptations. Addressing these dynamics presents opportunities for system- and practice-level improvements, including standardising documentation workflows, optimising electronic medical record functionality, and strengthening care pathways between acute and community settings to support continuity of nutrition care.