Physician desires were incorporated into a note writing protocol for outpatient dietitian notes. A group of possible questions was edited and condensed to address important aspects of outpatient note content, included were the following: subjective information, nutritional impact of disease state, documentation of nutritional goals, explanation of nutritional recommendations, recommendation rational, and analysis of lab data. These questions were made into a survey which asked physicians to rate each of these areas on a 5 point scale with 5 being essential and 1 being unimportant according to importance and the current performance of Registered Dietitian's on a 5 point scale with 5 being outstanding performance and 1 being poor performance in these areas.

Of the 138 surveys that were sent out, 35 were returned for a return rate of 25%. The results showed the physicians rated two areas as most important: the documentation of nutritional goals and thoroughness of nutritional recommendations scored the highest with mean scores of 4.3. The current performance of RD's in the area of documentation of nutritional goals was rated the highest with a mean score of 3.7. They received a lower rating in the area of thoroughness of recommendations with a mean score of 3.3. These results point out the need for improvement in the thoroughness of the nutritional recommendations on outpatient notes. The documentation of nutritional goals should also be examined even though it was rated as the best performance area since it too can benefit from clearer documentation. Overall, these results point out the importance of a periodic needs assessment as part of quality improvement when dealing with other health care providers. By making our notes more customer friendly, we can better meet the needs of our patients by making our notes more appealing to physicians, who could refer more patients for nutritional counseling.