An Acuity Based Clinical Nutrition Staffing Model Improves Acute Care Clinical Effectiveness and Maintains Program Viability in a Managed Care Environment

Abstract

An acuity based clinical nutrition staffing model was developed at a 395-bed, community hospital. The model allowed for the delivery of timely, appropriate, and frequent medical nutrition therapy needed to optimize patient outcomes and reduce the cost of care for patients at high risk for malnutrition. This approach to nutrition care contributed to the organization's strategic clinical effectiveness initiative. The process of identifying high risk for malnutrition and providing nutrition care services included a method of systematic capture of data about the acuity of the patient population and level of care needed. This data were used to determine the clinical staffing required for initial and follow-up interventions based on predictable service intensity. The requirement for clinical dietitian staffing is at a ratio of 3.5 follow-up to initial visits per patient at high risk for malnutrition which, is 17% of the adult hospital population. Patient acuity was based on major and minor complications, functional status on admission, and albumin depression on admission (R 2=0.8862). These predictors, along with medical diagnostic class, level of nutrition care and number (♯) of dietitian interventions had a strong association with LOS (R 2=0.6174)(patient acuity chi 2=29.7; level of nutrition care chi 2=57.4; ♯ of interventions chi 2=306.4, p<0.001). Utilization of the model has maintained clinical dietitian staffing in the face of organization downsizing. Acuity based staffing can position clinical nutrition services for success in a managed care environment.