Predictors of Dietitian Referrals in Hospitals

Abstract

Dietitian involvement has considerable benefits for hospitalized patients, resulting in better health outcomes and improved quality of life. However, dietitian referral routines are often inappropriate in hospitals. The aim of this study was to identify predictors for dietitian referrals in hospitalized patients. This study was performed on data collected in an annually conducted cross-sectional study (in the years 2017, 2018, 2019). A standardized questionnaire was used to collect data, and logistic regression and a generalized estimating equation (GEE) model were used to calculate the associations between the patient characteristics and dietitian referrals. In the final GEE model, the following predictors for dietitian referrals remained significant: diabetes diagnosis (OR 1.80), cancer diagnosis (OR 1.76), digestive disease diagnosis (OR 2.03), presence of a pressure injury (OR 1.58), risk of malnutrition based on body mass index (BMI) and weight loss (OR 1.72), risk of malnutrition based on the malnutrition universal screening tool (MUST) (2.55), and the application of any malnutrition screening at admission to hospital (2.20). Total dietitian referral rate was 16.8%. The highest rate of dietitian referrals was found in patients with a risk of malnutrition (37%). This study included a large sample of hospitalized adult patients and revealed a low dietitian referral rate among these patients. These results indicate that dietitian involvement in hospitalized patients with nutrition-related conditions urgently needs to be improved.

Using an interactive nutrition technology platform to predict malnutrition risk

“…European, US and Australian best practice guidelines all recommend nutrition risk screening using a validated tool and subsequent referral to a dietitian for those identified at risk for all hospital patients. 4,31,32 The dietitian referral rate of 45% for those 'at risk' of malnutrition is consistent with an international 45-hospital study involving 8405 patients reporting that 37% of people at risk of malnutrition were referred to a dietitian, 6 as well as an Australian study reporting that 45% of individuals at risk of malnutrition were being managed by a dietitian. 7 Together, these findings indicate that best practice standards for management of malnutrition are not being achieved.…”

“…2,3,5 A 2020 cross-sectional study across 45 Austrian hospitals over three years found that malnutrition screening was inadequate or not completed in 50.2% of the study population (n = 8405 individuals). 6 In this study, 46.6% of people identified as at risk of malnutrition through screening were not referred to a dietitian. 6 Similar findings were reported in an Australian study published in 2012.…”

“…6 In this study, 46.6% of people identified as at risk of malnutrition through screening were not referred to a dietitian. 6 Similar findings were reported in an Australian study published in 2012. 7 Best practice guidelines recommend that individuals identified at risk of malnutrition should be referred to a dietitian for assessment and diagnosis using a validated assessment tool such as the Subjective Global Assessment.…”

“…Research indicates that screening and referral of patients at risk of malnutrition is not adequate in many hospitals. 1,3,6 Ancillary and nursing staff are often responsible for the multi-step malnutrition screening and referral process, but are time poor and have multiple, conflicting commitments. 5,27,30 This study suggests that the Nutrition Dashboard could be used in parallel to existing MST screening by providing dietitians with the nutrition risk information directly to improve the timely identification of likely malnutrition.…”

Individual-Level Factors are Significantly More Predictive of Employee Innovativeness Than Job-Specific or Organization-Level Factors: Results From a Quantitative Study of Health Professionals

“…Alternately, it may be that the form innovations take in health professionals’ practice differ from the form innovations take in other studied professions and that innovation in the health professions is well-served by both achievement and dependability. Dietetics, specifically, is a small health profession whose members report feeling as though their role is undervalued 102,103 (including monetarily 104 ) and misunderstood 51,103,105 ; thus, there are strong incentives to be dependable and to avoid rocking the boat. 106 Providing consistent, high-quality care may appear to be the safest path to recognition and clarity surrounding the roles of small health professions among interdisciplinary team members.…”