Justification for Increased Staffing Utilizing A Computerized Program for Documenting Productivity and Direct Patient Care

Abstract

Dietetics is a diversified profession which must be marketed as an efficient use of resources in the delivery of quality patient care if it is to survive the transitions of health care reform. The shift in patient care is toward preventive medicine and outpatient care. However, more critically ill patients are being hospitalized requiring specialized nutritional care. In this facility, in spite of the abundant reduction in FTE, within the past 3 years, the clinical dietetics staff has been increased by 1 FTE and 3 fee basis (contract) registered dietitians. Justification of staffing need waa based on productivity rate which was defined as actual time accounted for using a computerized system by the dietitian based on a 7.5 hour workday. Each clinical dietitian utilized a computerized encounters program calibrated in minutes to account for their time on duty. All encounters were defined, calibrated, and approved by the clinical staff prior to implementation. Direct patient care was defined as activities which directly involved the patient and dietitian interaction. The standard set was a minimum of 75% of their productivity time should be accounted for and of that time, a minimum of 50% of that time must be spent in direct patient care. The current inhouse workload averages 30 to 45 beds per dietitian depending on the ward percent turnover rate and type of patients on assigned ward. In addition, each clinical dietitian is assigned one or two maximum specialty clinics for providing outpatient care. As a result of this reorganization, the number of outpatient clinic visits for nutrition intervention rose from 2640 to over 4600 in just one year for an overall increase of 57%.