Registered dietitian activities in a department of veterans affairs medical center: Patient care vs non-patient care

Abstract

The Little Rock Veterans Affairs Medical Center (VAMC) implemented a computer-based activities/intervention record tracking system called “Encounters Program” in 3/91. Retrospective review of 14 months of data entry (1/1/92–2/28/93) evaluated the use of time by clinical dietetic staff in direct patient care (DPC) vs. non-patient care (NPC) with the purpose of identifying NPC activities that might be reduced or eliminated. A total of 49 “encounters” were developed (11 defined as NPC), which are used by the clinical staff to record daily work activities. Automatic default times for each encounter exist, or the clinician may enter a different time as required. Monthly review by the clinical manager evaluates work volume, time usage, and patient care complexity for clinical staff. Results of 14 months of data collection showed a total of 42,284 encounters consuming 27,359 hours. DPC functions represented 86% (36,398) versus NPC at 14% (5,886), however, when addressing time, DPC functions consumed 65% (17,053) hours vs. 35% (9,143 hours) for NPC activities. The cost of NPC activity is approximately $11,768 per year at this VAMC based upon the median clinical dietetic staff salary. While no standards define the percentage of time that is expected in patient Vs non-patient care, the clinical manager can evaluate the time requirements for specific clinical programs and patient care activities. Further analysis of the encounters statistics for each clinician on a monthly basis provides data that identifies effective time managment throughout the year, which may be used for clinical dietetic staffing and performance evaluations. A comprehensive time assessment instrument for tracking clinical dietetic staff functions is essential in evaluating the efficacy of staffing and in assessing the time required for direct patient and non-patient care activities. Results of these data may then be used by the clinical manager to reduce waste (time) and improve patient care by increasing direct patient care contact.