Background: The rate of malnutrition among hospitalised elderly patients in Australia is 42.3%. Malnutrition is known to lead to significant adverse outcomes for the patients and increase hospital costs through increased use of resources. Aim: This study assessed nutrition screening adequacy and investigated factors associated with missed opportunity to diagnose malnutrition. Methods: A prospective cross-sectional study involving 205 general medical patients aged ≥60 years admitted acutely in a tertiary hospital over a period of 1 year. Patients who were not given initial nutritional screening were noted and all patients underwent nutritional assessment. The researchers assessed demographic data and performed univariate analysis of factors responsible for missed nutritional screening. Results: Only 99 patients (49.5%) were screened for malnutrition and 100 (50.3%) missed initial nutritional screening (data incomplete for 6 patients). Of those screened, more were malnourished (n=64; 61.5%) than those not screened (n=40; 38.5%), p<0.001. There was no significant difference in screening rates over the weekends and public holidays compared with weekdays (p=0.14). Time of day (p=0.03) and ward location (p=0.001) were significant factors, which determined nutrition screening. Conclusion: This study indicates common associations that might explain low inpatient screening rates for malnutrition; these include apparently adequate nutritional status, lower staff to patient ratios and outlier ward locations. Ensuring consistent nutrition screening with appropriate therapeutic interventions for patients and educational interventions for staff could pay dividends not only in terms of improved patient health but also in terms of hospital reimbursement.