The National Clinical Effectiveness Committee (NCEC) requires consideration of evidence on both the clinical and cost-effectiveness of health technologies in the development of all National Clinical Guidelines in Ireland. The role of HRB-CICER is to independently review evidence and provide scientific support for the development, by guideline development groups, of these evidence-based National Clinical Guidelines.



The overall aim of National Clinical Guideline No. 22 is to improve patient health outcomes and experience during hospitalisation, by standardising practice and improving decision-making on preventing, identifying and treating malnutrition risk.  As part of the development of this National Clinical Guideline, HRB-CICER conducted a systematic review of the clinical effectiveness and cost-effectiveness literature. This involved:

1. A systematic review of the clinical literature on nutritional screening tools for adult patients in acute hospital settings.
2. A systematic review of the cost-effective literature on nutritional screening tools for adult patients in acute hospital settings
3. An update of the evidence tables from Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition, published by the National Institute for Health and Care Excellence (NICE) in the United Kingdom (last updated July 2017).  

Malnutrition affects a significant proportion of adult patients in hospital with nearly one in three patients having clinically relevant signs of undernutrition on admission.  Undernutrition is associated with significant adverse events such as depression of the immune system, impaired wound healing, and muscle wasting, which can result in a longer hospital stay, higher treatment costs and increased mortality. The early identification of patients at risk of malnutrition in hospital and the provision of timely and appropriate oral nutrition support to those patients who are malnourished or at risk of malnutrition is vital.  

The systematic review of the literature to support the development of National Clinical Guideline No. 22 was carried out in accordance with agreed HRB-CICER processes and following the HIQA guidelines for the retrieval and interpretation of economic literature.