Patient Malnutrition Risk or Number of Initial Nutrition Intervention Categories Can Be Used to Develop Registered Dietitian Nutritionist Staffing Models in the Inpatient Adult and Pediatric Hospital Setting: A Cohort Study

Abstract

BackgroundMore data are needed to guide evidence-based, inpatient registered dietitian nutritionist (RDN) staffing models. ObjectiveIdentify relationships between: 1) patient malnutrition risk or intervention categories and estimated total RDN care time (“care time”); and 2) care time and emergency department (ED) visits. DesignThis study was a prospective cohort study with data collection via RDN surveys, patient interviews, and medical record review. Participants/settingAdult (n = 550) and pediatric (n = 345) patients enrolled at 32 adult and 27 pediatric US hospitals from August 2019 to January 2023. Main outcome measuresCare time and ED visits within 90 days of hospital discharge were measured. Statistical analysisMultilevel, generalized linear, and negative binomial regression models were used to evaluate relationships between patient characteristics and Box-Cox–transformed care time and the relationship between Box-Cox–transformed care time and total ED visits. ResultsAfter adjusting for patient characteristics, adult patients classified as at malnutrition risk vs not at risk required a mean of 8% (95% CI 5% to 11%) more care time. Pediatric patients at medium or high compared with low malnutrition risk needed a mean of 21% (95% CI 4% to 40%) and 31% (95% CI 12% to 54%) more care time, respectively. Number of initial RDN interventions categories per patient (0 to 1 vs 2 to 3 or 4+) was associated with a mean of 10% (95% CI 7% to 14%) or 8% (95% CI 2% to 15%) more care time for adults and 17% (95% CI 5% to 32%) and 39% (95% CI 21% to 61%) more care time for children, respectively. More estimated total RDN care time was associated with significantly higher incidence rate ratios of ED visits (adults: incidence rate ratio 2.8; 95% CI 1.1 to 7.2; children: incidence rate ratio 1.7; 95% CI 1.02 to 2.8). ConclusionsPatient malnutrition risk or breadth of nutrition interventions required can inform nutrition department staffing. Intervention studies may better define relationships between care time and medical outcomes.