Performance Indicators


The Dutch Health Care Inspectorate, which is part of  the Dutch Ministry of Health, has established 17 Performance Indicators on which hospitals have to report annually and which are used for benchmarking between hospitals. Screening and the treatment of malnutrition in hospitals have become part of this set of indicators since 2007. Every summer the previous  year’s data are published and both the Health Care Inspectorate and the media then use them for quality rating of hospitals. In 2013, screening of hospitals outpatients has been added to the malnutrition indicator.

Performance Indicator: adult inpatients

The performance indicator on malnutrition screening in adult patients requires that all patients ≥ 18 years need to be screened within 24 hours after admission. Screening should be performed with a validated screening tool. Treatment of malnutrition is measured by the percentage of malnourished patients with an adequate protein intake (defined as: 1,2 – 1,5 gram/per kg/day) at the fourth day of hospital admission.

Screening (adults)
Do you systematically screen nutritional status of all adult patients on admission to hospital? Yes / No
What screening tool is used for malnutrition screening? SNAQ / MUST / other
A Number of adult patients admitted to hospital (>24 hours) in year of report * n
B Number of adult patients screened at hospital admission n (%)
C Number of adult patients screened as moderately malnourished n (%)
D Number of  adult patients screened as severely malnourished n (%)

* Patients in maternity ward or with planned admission for < 24 hours are excluded from this measurement

Treatment (adults)
What type of measurement was performed? (preferably continuous measurement) Continuous / subsample
A Number of malnourished adult patients with >4 days admission n
B Number of malnourished adult patients with adequate protein intake on 4th day of admission * n (%)

* Optimal protein intake is defined as: 1,2 – 1,5 gram/per kg/day.

In 2016, we published the results of the screening indicator of the past years. This study provides benchmark data on the prevalence of undernutrition, including more than half a million patients. One out of 7 patients was scored as undernourished. For geriatrics, oncology, gastroenterology, and internal medicine, this ratio was even greater (1 out of 3–4). Hospital stay was 1.4 d longer among undernourished patients than among those who were well nourished.