Inpatient Staffing Needs for Registered Dietitian Nutritionists in 21st Century Acute Care Facilities

Hand, Rosa K.; Jordan, Barbara; DeHoog, Susan; Pavlinac, Jessie M.; Abram, Jenica K.; Parrott, J. Scott

doi:10.1016/j.jand.2015.01.013

Cited by 21 publications

(7 citation statements)

References 11 publications

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“…When preparing military-to-civilian transition of RD staffing, the NuOp considered existing military field hospital staffing models, as well as staffing models that are traditionally applied in acute care settings [ 10 , 51 , 52 , 53 , 54 ]. However, these models are not directly transferable to military field hospitals with civilian augmentations, such as the JNYMS, which required longer times for completing patient assessments due to the absence of an EMR, donning and doffing full PPE, locating patients amid transfers, coordinating care with medical and nutritional personnel, documenting MNT recommendations, and balancing the completion of clinical and food service roles.…”

Section: Challenges and Solutionsmentioning

confidence: 99%

Providing Food and Nutrition Services during the COVID-19 Surge at the Javits New York Medical Station

Sanchez

Gelfand

Perkins

et al. 2021

IJERPH

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Military field hospitals typically provide essential medical care in combat zones. In recent years, the United States (US) Army has deployed these facilities to assist domestic humanitarian emergency and natural disaster response efforts. As part of the nation’s whole-of-government approach to the coronavirus disease (COVID-19) pandemic, directed by the Federal Emergency Management Agency and the Department of Health and Human Services, during New York City’s (NYC) initial surge of COVID-19, from 26 March to 1 May 2020, the US Army erected the Javits New York Medical Station (JNYMS) field hospital to support the city’s overwhelmed healthcare system. The JNYMS tasked a nutrition operations team (NuOp) to provide patient meals and clinical nutrition evaluations to convalescent COVID-19 patients. However, few guidelines were available for conducting emergency nutrition and dietary response efforts prior to the field hospital’s opening. In this case study, we summarize the experiences of the NuOp at the JNYMS field hospital, to disseminate the best practices for future field hospital deployments. We then explain the challenges in service performance, due to information, personnel, supply, and equipment shortages. We conclude by describing the nutrition service protocols that have been implemented to overcome these challenges, including creating a standardized recordkeeping system for patient nutrition information, developing a meal tracking system to forecast meal requirements with food service contractors, and establishing a training and staffing model for military-to-civilian command transition. We highlight the need for a standardized humanitarian emergency nutrition service response framework and propose a Nutrition Response Toolkit for Humanitarian Crises, which offers low-cost, easily adaptable operational protocols for implementation in future field hospital deployments.

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Section: Challenges and Solutionsmentioning

confidence: 99%

Providing Food and Nutrition Services during the COVID-19 Surge at the Javits New York Medical Station

Sanchez

Gelfand

Perkins

et al. 2021

IJERPH

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“…This issue is not limited to the UK, with international studies reporting lower than anticipated therapy staffing levels. [19][20][21][22] Reasons for this include lack of evidence and recognition of the Open access roles, 23 lack of funding but also lack of available appropriately trained staff able to work within critical care. 24 Participants in this study raised the source of funding for therapy posts, for example, critical care or therapy department funded, as having a direct impact on the ability for therapy staff to become fully integrated within the critical care MDT.…”

Section: Working Practicesmentioning

confidence: 99%

Exploration of therapists’ views of practice within critical care

et al. 2021

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IntroductionTherapists are increasing recognised as core members of the critical care multiprofessional team. Each therapy profession provides specialist assessments and interventions, but also work collaboratively across the rehabilitation pathway. Despite inclusion in several national guidance documents, there remains a lack of evidence regarding the perceived role of therapists working within critical care, the unique contributions of each profession and opinion on the day-to-day tasks and responsibilities of each therapy profession.MethodA descriptive qualitative methodology was used involving seven focus groups. Purposeful sampling was used to recruit therapists via professional specialist interest groups. All focus groups were uniprofessional and discussions based on a predesigned framework. Data were analysed thematically.ResultsParticipants (n=65) from across the UK were recruited to seven focus groups with an average of 18.3 years postgraduate clinical experience of which 11.6 years was within critical care. Three core themes were generated from 875 codes and 237 potential subthemes. The final themes were (1) professional characteristics; (2) multidisciplinary team and (3) staffing. An additional theme of ‘COVID-19 pandemic’ was also identified. Findings were similar across all profession groups particularly regarding the need for holistic, patient-centred care. Expected variation was observed for professional characteristics especially regarding specific assessments and interventions.DiscussionTherapy services are an essential component to the delivery of critical care especially regarding recovery and rehabilitation. Through three core themes, this qualitative study has provided new evidence of the perceptions and opinions of the role that therapists undertake within critical care.

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“…Four recent studies [10][11][12]16 (three in the hospitalised patient setting and one in the outpatient setting) used work sampling tools to measure dietitian time, with multiple ways of categorising time spent (direct vs. indirect) within each study. In the hospitalised patient studies, percentage of time spent providing direct patient care varied from 50% to 84%, whereas, in the single-site outpatient study, 20% of time was spent providing faceto-face patient care.…”

Section: Introductionmentioning

confidence: 99%

Electronic health record time‐tracking provides real‐time data to measure and benchmark dietitian productivity

Crouse,

Feuling,

Winter

et al. 2023

J Human Nutrition Diet

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BackgroundTraditional methods for benchmarking dietitian productivity are time‐consuming and fail to accurately measure the total time spent providing nutrition care. An electronic health record (EHR)‐based tool that allows for daily tracking of both face‐to‐face and patient care coordination time for dietitians was created. We assessed whether it provided consistent, continuous measurement of time and productivity.MethodsThis tool was created in an independent paediatric academic healthcare system in the USA. Time spent by dietitians in face‐to‐face settings and care coordination were tracked. Changes in time spent between the years 2013–2016 versus 2018–2019 were also analysed.ResultsThe outpatient dietitian spent a mean total of 66.4 min per patient (37.8 ± 6.0 min in face‐to‐face care and 28.6 ± 5.2 min in care coordination). The total times and fractions spent on face‐to‐face and care coordination time varied by specialty. Comparison of the two periods of time revealed 75% more productivity on average of dietitians in different outpatient settings after including care coordination tracking. In addition, dietitians were more likely to document time spent in 5‐min increments after the institution of this methodology as opposed to 15‐min increments.ConclusionsAn EHR‐based tool that facilitates the documentation of both face‐to‐face time and patient care coordination time is feasible and enables consistent, continuous measurement of time and productivity. The real‐time data from this tool can be used to support adequate dietitian staffing and be used to create a multicentre database to measure the actual time dietitians need to provide care and generate consistent staffing benchmarks.

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Inpatient Staffing Needs for Registered Dietitian Nutritionists in 21st Century Acute Care Facilities

Cited by 21 publications

References 11 publications

Providing Food and Nutrition Services during the COVID-19 Surge at the Javits New York Medical Station

Providing Food and Nutrition Services during the COVID-19 Surge at the Javits New York Medical Station

Exploration of therapists’ views of practice within critical care

Electronic health record time‐tracking provides real‐time data to measure and benchmark dietitian productivity

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