The accurate diagnosis and subsequent treatment of malnutrition is an essential component of nutrition care because of the known negative impacts of malnutrition on patient outcomes. The detection of malnutrition is influenced by disease-specific characteristics, practice settings, and the availability of resources. This article explores how malnutrition diagnosis through the application of the Global Leadership Initiative on Malnutrition global consensus on malnutrition diagnostic criteria is impacted by the unique characteristics of the heart failure, oncology, and trauma populations. (Nutr Clin Pract. 2020;35:85-97)

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156 Background: Unidentified psychosocial and nutrition needs can impede a patient’s quality of life during cancer treatment. Nutritional, social, and logistical patient needs may be overlooked without a standardized identification process. With the increasing use of the electronic medical record (EMR), simple screening tools to identify psychosocial needs and nutritional concerns can be implemented. Methods: The University of Pennsylvania’s Department of Radiation Oncology integrated a simple six-question “yes” or “no” response screen directly into the nursing assessment in the EMR to quickly and easily trigger high-risk patient referrals to social work and nutrition services. The screen identifies multiple patient needs (i.e. home supports, weight loss) in a formalized approach across distinct time periods in the treatment course. Staff collected data on new patient encounters and the subsequent referral source (i.e. screen, physician). Results: For social work, 24.5% of the new patient referrals from July 2013 – February 2014 were triggered via the screening tool in the EMR. While it is not clear from this data that overall referrals to social work increased due to the screening tool, it can be inferred that these patients were identified earlier in the treatment trajectory for supportive services. For nutrition services, 51.2% of new patient referrals were triggered via the screening tool. A comparison of data prior to the implementation of the screen in January 2012 showed a 78% increase in nutrition referrals triggered by the screen. Conclusions: This method facilitates quick intervention and fosters better communication among staff. The screen allows the staff to readdress psychosocial and nutrition impact symptoms on a regular basis and provide appropriate interventions along the continuum of care. The screen also reduces the subjectivity of medical staff referrals and is an additional measure to identify oncology patients who would otherwise be overlooked. Lastly, the screening tool in the EMR denotes a targeted intervention and contributes to the establishment of a supportive patient relationship.

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