Abstract
Malnutrition is a common issue in healthcare settings and, despite often being both preventable and treatable, it continues to affect 30%-40% of patients in Australia. This scoping review aimed to synthesise the literature addressing the prevalence of malnutrition, to identify strategies implemented to address malnutrition in Australian hospitals since 2000, using a systems thinking focus to identify opportunities for systems redesign. A comprehensive search of four online databases (Web of Science, Medline, CINAHL and Scopus) was undertaken from January 2000 to October 2025 for studies reporting on malnutrition prevalence and related assessment practices in Australian acute hospitals. Screening and data extraction were conducted in duplicate. From 1055 records screened, 151 studies were included. The mean of means nutrition screening completion rate was 71.7% ± 25.0, with 49.8% ± 18.3 of patients identified as at risk of malnutrition. Reported barriers to malnutrition screening included heavy workloads, poor leadership, lack of role clarity, and ward culture. The prevalence of malnutrition was 38% ± 8.3. Interventions were predominantly patient-focused, including oral nutritional supplements, high-energy/high-protein meals, meal fortification, and patient education. Three studies addressed hospital-level or system-wide approaches such as patient-centred programmes and the implementation of a new malnutrition pathway. Malnutrition risk and prevalence remain high among Australian hospitalised adults. Current strategies are largely reactive, addressing malnutrition only after it is identified, therefore, a shift towards proactive, system-wide prevention is needed. Applying a systems thinking approach may help to overcome barriers and provide sustainable and effective models of care.