Nutrition screening boosts care for trauma patients at Royal Alex

‘What’s powerful is how something this small can improve the care journey’

Story by Jason Morton | Photos by Evan Isbister

EDMONTON — It started with a gap. Clinical Nurse Specialist Stacey Middleton was combing through trauma data at the Royal Alexandra Hospital (RAH) when she noticed something troubling — older trauma and surgical patients weren’t healing as well as expected. The numbers weren’t just numbers. They were people struggling to recover.

“Screening for risk of malnutrition wasn’t part of nursing practice in trauma and surgical units,” she says. “It wasn’t built into our process — and we were missing patients who needed help.”

Registered Dietitian Karmyn Cheung noticed the same issue. “We’ve always screened patients for malnutrition and provided interventions, but with so many patients to see each day, we couldn’t identify everyone. Some patients who could have benefited from timely nutrition support were being missed.”

This realization sparked a team effort to make nutrition a priority from the moment a patient is admitted.

Since April, trauma and surgical patients at RAH are screened for malnutrition risk using a simple two-question tool in Connect Care. If the screen shows risk, a referral to a dietitian is entered.

It’s a small change — but one with big impact.

“What’s powerful is how something this small can improve the care journey,” adds Middleton.

Screening rates, once non-existent in these units, now consistently top 80 per cent. That means more patients are identified early — especially seniors, cancer patients, and those facing food insecurity.

For trauma and surgical patients, early detection is critical.

“It’s like their body is running a marathon just to heal,” Cheung says. “Without enough calories or protein, wounds don’t mend well, infections can set in, and recovery slows.”

She compares proper nutrition to fuel for healing. “Without it, patients lose strength so quickly they can’t walk or care for themselves. We’re trying to prevent that. We’re giving them the best chance to get back to living their normal.”

The success of the initiative stems from collaboration among nurses, dietitians, educators, surgeons, and data analysts. “We’re using data to drive behaviour change,” Middleton says. “Once we started posting results, people saw the impact — and wanted to do better.”

With support from Dr. Lisa Martin, lead for Nutrition Services Research and Evaluation, the trauma and surgical team is now using Connect Care dashboards to track progress and keep momentum. The work also aligns with Alberta’s Clinical Business Intelligence initiative, a provincial priority that uses data to improve patient care.

“This isn’t just a nursing project,” says Middleton. “It’s a shared effort. Nutrition is care. It’s healing. It’s dignity. And it starts with a question we should have been asking all along.”