Background:
In 2014, The Federal Register published part II of the centers for Medicare & Medicaid Services; including a section related to food and dietetic services. It states that Registered dietitians (RDs) are the professionals who are best qualified to assess a patient’s nutritional status and to design and implement a nutritional treatment plan in consultation with the patient’s interdisciplinary care team. Furthermore, in order for patients to have access to the timely nutritional care that can be provided by RDs,a hospital must have the regulatory flexibility either to appoint RDs to the medical staff and grant them specific nutritional ordering privileges or to authorize the ordering privileges without appointment to the medical staff, all through the hospital’s appropriate medical staff rules, regulations, and bylaws.
After discussions among dietitians and physicians and a presentation to the executive committee of the medical board, it was clear that there are diverse opinions about expanding the role of dietitians in the inpatient service.
We aim to compare perceptions among dietitians, trainees in internal medicine and surgery, and attending physicians about diet and TPN orders for hospitalized patients.
Methods:
Using survey Monkey, our IRB approved study consisted of an anonymous 10-questions survey that is designed to compare perceptions among RDs and MDs (trainees in internal medicine and surgery, and hospitalists) about diet and TPN orders for hospitalized patients. Statistical analysis using Chi Square was performed to compare the answers. A p value below 0.05 was considered statistically significant.
Results:
48 Physicians and 34 dietitians completed the survey.
No differences were seen in questions about following dietitian recommendation (Q1), importance of dietitians in the health care team (Q5) or experience at work (Q10).
There were differences in perception between the 2 groups in 7 out of 10 questions.
MDs ordered only 10 to 20% of the time nutritional intervention that exceed a diet order (i.e. supplements) compared to RDs who answered more than 50% of the time (Q2).
MDs communicated with RDs in only 10-20% of the time while RDs communicated more than 50% of the time with the physicians (Q3).
MDs believe the communication with RDs is highly effective while the latter think that it needs reinforcement and clarification (Q4).
Regarding TPN, tube feeding and diet orders, physicians would be more comfortable reviewing those orders prior to implementing them, while RDs feel comfortable issuing them without a physician review (Q6, 7, 8).
Finally, MDs are very uncomfortable with drug-nutrient interactions while RDs and very comfortable (Q9).
Conclusions:
This study shows that differences in perceptions exist between physicians and dietitians in inpatient setting regarding effective communication, enteral and parenteral orders, and drug/nutrient interaction.
Focus groups for MDs and RDs and nutrition conferences to MDs should be considered to try to resolve those differences for a better patient care and treatment.