Background. Food waste comprises up to 50% all waste in hospitals. Therefore effective strategies are required to manage and dispose of waste generated in hospital foodservices to minimise environmental impacts. Aims. To investigate strategies used in hospital foodservices that divert food waste from landfill and report their financial, environmental and staffing outcomes and the barriers and enablers to implementation. Methods. A systematic review was conducted searching seven electronic databases, Google Advanced and 19 targeted websites. Two step selection was completed in duplicate to find records about reuse, recycling or recovery of energy from food/food related waste compared to sending it to landfill in a hospital food service and the financial, environmental or staffing outcomes. Quality of peer reviewed studies was assessed with a validated tool. Results. Four peer reviewed and 72 grey literature documents reported on 80 food waste management strategies: food donation (n=20); animal feed (n=2); industrial use (n=9); composting (n=32) and other (n=17). These approaches had the capacity to reduce waste hauling fees (n=14) and reduce staff handling of waste (n=3) in addition to decreasing the amount of waste sent to landfill. Barriers were contamination of waste streams and equipment problems while enablers included leadership and time-neutral changes. Conclusion. This review highlights many examples of hospital foodservices managing their food waste responsibly, and the benefits. Dietitians can use this evidence to advocate for strategies that divert food waste away from landfill. Copyright © 2021 Dietitians Australia. All rights reserved.