An innovative dietetic service on an acute assessment unit is feasible and effective in ensuring early dietetic intervention to detect patients at risk of malnutrition and optimise their nutritional status

Abstract

Aim To evaluate the feasibility and impact of a Band 7 (B7) dietitian proactively screening all patients admitted to a 70 bed acute assessment unit (AAU) at a busy district general hospital to optimise early access to dietetic assessment, identify unmet nutritional needs and ensure personalised nutritional management (PNM). Method A 12-week pilot project seconded a highly specialised B7 dietitian with diverse clinical experience into the multidisciplinary team (MDT) on the AAU, full-time Monday to Friday. The dietitian attended daily interdisciplinary meetings where all current patient's needs were reviewed. All patients were actively screened by the dietitian and those identified to have a potential unmet nutritional need received a face-to-face holistic dietetic assessment. The assessment included review of the patient's priorities and goals, anthropometry, MUST score, recent nutritional intake, evaluation of malnutrition risk and need for nutritional support including parenteral and enteral nutrition. A PNM plan was created for each patient before leaving the unit which ranged from food first advice with oral nutritional support, through to initiation of enteral feeding with close monitoring of electrolytes in patients at risk of refeeding syndrome. Where appropriate, patients were referred on to community or specialist dietetic teams. Data was collected throughout the pilot on patient numbers, demographics, diagnoses, time from admission to dietetic assessment, MUST score and dietetic intervention. Conclusion * 117 new patients were seen within the pilot. * Total number of individual patients receiving dietetic assessment in the AAU increased by 68%. * Total number of patients with a respiratory or gastroenterology diagnosis receiving dietetic input increased by 45% across the whole hospital. * 90% of patients with an identified dietetic need were seen within 2 working days of admission to the AAU. * Patients on the AAU referred to dietetics but discharged before receiving assessment improved by 90%. * Every patient with an enteral or parenteral feeding device was assessed by the dietitian within 1 working day of admission to AAU (Monday to Friday). * All patients assessed by the AAU dietitian received a PNM plan. * Improved support to junior dietitians across the hospital through first contact B7 dietetic assessment. A B7 dietitian in the AAU MDT is feasible as this augments the MDT on the AAU bringing sufficient experience to assess and manage complex patients in the unstable stage of illness and effective in ensuring early dietetic assessment and PNM for patients, with positive impact across the wider dietetic service and hospital.