To whom should concerns of suspected malnourishment in vulnerable populations be reported?

Reporting Concerns of Suspected Malnourishment

When malnutrition is suspected in vulnerable populations, concerns should be reported to a registered dietitian or nutrition expert for detailed assessment, with documentation in the patient's medical record and communication to the treating physician for coordinated care planning. 1

Immediate Reporting Pathway

Primary Contact for Assessment

• A registered dietitian or nutrition expert should be the first point of contact when screening identifies patients at risk of malnutrition, as they are specifically trained to perform detailed nutritional assessments and develop treatment plans 1, 2
• The treating physician must be notified simultaneously to ensure malnutrition is documented in the medical record and appropriate interventions are ordered 3, 4

Documentation Requirements

• All findings from nutritional screening must be documented in the patient's health record, including the specific screening tool used and the results 1, 2
• For hospitalized patients, nutritional status should be assessed and documented at admission and periodically throughout the hospital stay, with reassessment every 1-6 months in outpatient settings 1

Specific Reporting Protocols by Setting

Hospital Inpatients

• Nutrition screening should occur within 24 hours of admission, with immediate referral to a registered dietitian if the patient screens positive for malnutrition risk 1, 5
• The multidisciplinary care team (physicians, nurses, dietitians, pharmacists) should be informed through the medical record system to ensure coordinated nutritional intervention 2, 6
• For patients in intensive care units, daily monitoring and reporting to the medical team is essential during the acute phase 1, 7

Outpatient and Primary Care Settings

• Patients identified as at risk should be referred to a registered dietitian for comprehensive assessment, with rescreening every 3-6 months for stable patients 2
• The primary care physician should receive a formal consultation report from the dietitian outlining nutritional deficits and recommended interventions 2

Long-Term Care and Nursing Facilities

• Screening should occur immediately upon entry into the facility, with results reported to the facility medical director and nursing staff 1, 2
• Residents at nutritional risk require reassessment every 3-6 months, with findings documented in the care plan and communicated to all caregivers 2

Refugee and Displaced Populations

• Malnutrition surveillance data should be reported to the health information system coordinator, who compiles data for program decision-makers 1
• High prevalence rates of undernutrition (>10%) trigger mandatory reporting to public health authorities and require cross-sectional surveys repeated at 6-8 week intervals 1
• Individual cases of severe malnutrition should be referred to supplementary feeding programs, with enrollment tracked centrally 1

Critical Communication Elements

Information to Include in Reports

• Specific screening tool results (e.g., NRS-2002 score, MUST score, MNA-SF score) with numerical values 1, 2
• Presence of key malnutrition criteria: unintentional weight loss percentage, reduced dietary intake, loss of muscle mass, presence of inflammation 1, 2
• Current body mass index with notation if fluid retention (edema, ascites) affects interpretation 1
• Functional status including handgrip strength or performance measures if available 2

Urgency Indicators Requiring Immediate Reporting

• BMI <18.5 kg/m² in adults, which indicates the vast majority have sarcopenia and require urgent intervention 1
• Unintentional weight loss >5% in the past month or >10% in the past 6 months 1, 2
• Inability to consume adequate oral intake for >7 days 1
• Presence of severe disease with high metabolic demands (sepsis, major surgery, advanced organ failure) 1

Follow-Up Reporting Requirements

Monitoring and Reassessment Communication

• For severe malnutrition, weekly progress reports should be communicated to the medical team during hospitalization until nutritional status stabilizes 7
• Stable outpatients require reassessment reports every 3-6 months sent to the primary physician 2
• Any deterioration in nutritional status (weight loss >5%, albumin decrease >0.3 g/dL) must be immediately reported to the treating physician 7

Discharge Planning Communication

• Nutritional recommendations must be included in discharge summaries and communicated to outpatient providers, yet current data show <10% of at-risk patients receive discharge nutrition recommendations 4
• Home health agencies or long-term care facilities receiving the patient must receive detailed nutritional assessment findings and ongoing care requirements 2

Common Pitfalls to Avoid

• Do not delay reporting while waiting for laboratory results—screening findings alone warrant immediate dietitian referral 2, 5
• Do not assume physicians will recognize malnutrition—studies show physicians diagnose only 32% of cases identified by dietitians, particularly missing patients with BMI >18.5 3
• Do not report only to nursing staff without physician notification—malnutrition diagnosis requires physician documentation for appropriate coding and treatment authorization 3, 4
• Do not use informal communication channels—formal documentation in the medical record is essential for continuity of care and quality monitoring 1, 4