Utilization of a clinical nutrition staffing tool: A snapshot approach

Abstract

How many clinical dietitians are needed to provide quality nutritional care? Are current staffing patterns fair and equitable? These are difficult questions that clinical nutrition managers and their staff must address and act upon. At the University of Maryland Medical System, a 750-bed hospital, the clinical nutrition staff developed a tool in an effort to answer the above questions. A time allocation of 5.14 hours per R.D. day for clinical care was determined by subtracting from total available time, non-productive time plus time required for meetings, rounds and delays. Dietitians categorized all of their patients by level of nutritional risk and noted if education was needed. The staff estimated that the amount of time needed to provide adequate clinical care to patients at nutritional risk or in need of education was approximately 45 minutes every 3 days or 15 minutes per day and 30 minutes per day for patients on total parenteral nutrition. Total available time in relation to total needed time to care for patients at nutritional risk or in need of education was assessed for each R.D. Corresponding full time equivalents (FTEs) for R.D. positions were determined. By utilizing the staffing tool, we concluded that our present staffing level was inadequate due to a high patient acuity level (50% of patients were in need of nutritional assessment or counseling). In order to validate our findings, we utilized hospital data on total admissions per year combined with data on the percentage of patients at nutritional risk. This confirmed our findings regarding average number of patients in need of evaluation per R.D. per week. A time utilization study is planned in order to further stratify time requirements for patient care based on complexity. Also, these studies will be utilized to justify dietetic technician staffing and additional R.D. FTEs, if warranted. In summary, the utilization of a clinical nutrition staffing tool can provide a snapshot approach in assessing the adequacy of staffing patterns.