A tall order? An audit on the accuracy of recorded and patient-reported height on a university hospital ward

Introduction: Patient height is an important anthropometric measurement essential for nutritional assessment and screening. Often a subjective patient-reported height is used and is not objectively measured and recorded. The aim of this audit is to determine the accuracy of patient-reported height and height recorded in patient notes and whether inaccurate reporting impacts on body mass index (BMI) category and nutritional screening.

Method: The height of patients on the Hepatology ward at a University Hospital on a single day was measured by a Dietitian using an electronic stadiometer. Patient-reported height and height recorded in patient notes were also collected.

Results: A total of 27 patients were included, 52% female, mean age 64 (range 23–87). Height was recorded in the clinical notes for 15 (56%) patients. In all cases patient reported height was recorded in the notes as height was not objectively measured for any patient. 16 (59%) patients were able to stand to have height measured. It was not possible to measure height for 11 (41%) patients as they were unable to get out of bed due to poor mobility. Of the 16 patients who had height measured: 1 (6%) reported the same height as measured height; 12 (75%) reported their height as greater than measured height (range: 1–5 cm; mean: 3 cm); and 3 (19%) reported height as less than measured height (range: 1–2 cm; mean: 1.3 cm). The difference in measured height and reported height altered BMI by 0.2–2.1 kg/m2 (mean: 0.86 kg/m2) and changed BMI category according to the World Health Organisation categorisation in 4 (25%) patients, including incorrectly categorising one patient as overweight instead of a healthy weight.

Conclusion: This audit identifies the disparity between patient-reported and measured height with 75% of patients over-reporting and 19% under-reporting height. Furthermore, clinical staff may be faced with the challenge of estimating height in patients who are unable to stand. Inaccurate measurement of height may result in inappropriate nutritional advice or mask the risk of malnutrition and prevent the implementation of nutrition support. It is essential that all hospital wards have access to a stadiometer and height is accurately measured and recorded for all patients. As a result of this audit the ward stadiometer has been placed in an area easily accessible to patients and nursing staff. Results of the audit have been disseminated to ward staff and training has been provided to accurately measure and record height and estimate height by measuring ulna length for patients unable to stand. A re-audit is planned for 3 months following this training.