Study Design

Using Lean methodology, a collection of tools and concepts used to improve quality, safety, and efficiency of care delivery in the healthcare setting, the RDNs at ThedaCare Regional Medical Center identified that the validated NRS 2002 was missing patients at risk for malnutrition. To address this issue, the ThedaCare NRS was developed.23 The primary objective of this crossover intervention trial was to compare the sensitivity and specificity of the ThedaCare NRS when compared with the NRS 2002. To diagnose malnutrition, RDNs performed a nutrition assessment and an NFPE that used the 6 malnutrition clinical characteristics established by AND/ASPEN.8 The abbreviation RDNA is used throughout this article to indicate the administration of the nutrition assessments, which included the NFPE, performed by the RDN in the context of this study. The study protocol is shown in Figure ​Figure11.

Flow chart of study design and protocol. NDTR, nutrition and dietetics technician, registered; NFPE, Nutrition Focused Physical Exam; NRS 2002, Nutrition Risk Screen 2002; RDN, registered dietitian nutritionist; ThedaCare NRS, ThedaCare Nutrition Risk Screen.