Malnutrition and delirium are highly prevalent in hospitalised patients and share common risk factors. Malnutrition affects an estimated 38% ± 8.3 of patients in Australian acute settings (1), while approximately 8-14% of hospital patients acquire delirium during admission(2-4). The co-occurrence of both conditions is likely common, as patients with delirium are especially vulnerable to poor nutritional intake due to disturbed sleep-wake cycles, cognitive impairment that affects recognition of hunger or the ability to use cutlery, and behavioural disturbances that lead to missed meals which can compound the risk of poor clinical outcomes (5). There is limited data on prevalence of co-occurring delirium and malnutrition in general medical patients, and little is known about how nutrition care is delivered across the admission journey. This study aimed to determine the prevalence of co-occurring malnutrition and delirium, and to characterise nutrition screening, referral practices, nutrition assessment and their association with length of stay in patients with delirium at an acute tertiary hospital. A retrospective case series was conducted across six general medical units at Austin Hospital, Victoria, between January and July 2024. Of the 157 patients with a positive Confusion Assessment Method score for ≥5 days, 100 were randomly selected. Data were extracted from medical records, including demographics, admission details, delirium characteristics, nutrition screening and assessment, and nutrition interventions. Length of stay data were used to compare malnourished and well-nourished patients using the Mann-Whitney U test. Patient-journey timelines were constructed to illustrate distinct clinical scenarios representing various levels of nutritional statuses, such as well-nourished, at-risk, and malnourished patients. Among malnourished patients (n=16), 44% were automatically referred to a dietitian via the malnutrition screening tool, while 56% did not meet referral thresholds. 50% (19/38) of assessments competed in malnourished patients recorded that patients were unable to answer the weight loss question. 15.8% (6/38) of patients responded “no” to the weight loss question despite documented evidence of weight loss. Malnourished patients with delirium had a longer length of stay than delirium patients who were not malnourished (median 22.0 days, IQR 15.9–33.8 vs median 11.8 days, IQR 8.6–17.0; p <0.001). This study highlights gaps in malnutrition screening, potential under-referral to dietetics, and increased hospital length of stay in malnourished patients with delirium. Cognitive impairment appears to compromise the reliability of malnutrition screening questions in this population, suggesting current tools may under-detect malnutrition in patients with delirium. Tailored nutrition screening and referral pathways for patients with delirium may support earlier identification of those at risk, which may facilitate proactive nutrition intervention, with the potential to reduce hospital length of stay, support recovery, and improve the efficiency of healthcare delivery for this high-risk population.