title: Implementation of dietitian recommendations for enteral nutrition results in improved outcomes.
abstract: A primary role of the registered dietitian (RD) is to assess nutritional needs of patients in states of physiological stress and illness and to recommend changes to diet and tube feedings when warranted. However, implementation of changes is dependent upon the physician accepting the recommendations of the RD. This study evaluated outcomes of two groups of enterally fed patients in a long-term acute-care facility in northwest Louisiana: (a) those for whom the physician accepted RD recommendations; and (b) those for whom the physician did not accept RD recommendations. Data showed that physician-prescribed enteral formulas provided 10.0% less kilocalories and 7.8% less protein than the RD-assessed needs. t tests showed that when RD recommendations were implemented, patients had a significantly shorter length of stay (28.5+/-1.8 vs 30.5+/-4.8 days, P<0.05), as well as significantly improved albumin (0.13+/-0.17 vs -0.44+/-0.21 g/dL [1.3+/-1.7 vs -4.4+/-2.1 g/L], P<0.05) and weight gains (0.51+/-0.1 vs -0.42+/-0.2%, P<0.05) when compared to those who continued with physician's orders. These data suggest that if RDs had the authority to write nutrition orders and provide early nutrition intervention, patient care would improve.
authors.affiliation: Doctor's Hospital, Shreveport, LA, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Braga
authors.forename: Alice
authors.initials: A
authors.lastname: Hunt
authors.forename: Janet
authors.initials: J
authors.lastname: Pope
authors.forename: Elaine
authors.initials: E
authors.lastname: Molaison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D004044:Dietary Proteins / Q000008:administration & dosage; D004046:Dietetics / Q000379:methods / Q000592:standards*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000592:standards*; D005260:Female; D005521:Food Service, Hospital / Q000592:standards*; D006765:Hospitals, Convalescent / Q000592:standards; D006801:Humans; D007902:Length of Stay; D008134:Long-Term Care / Q000592:standards; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D010348:Patient Care Team; D010819:Physician's Role; D017410:Practice Guidelines as Topic; D017009:Professional Autonomy; D011787:Quality of Health Care; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D016896:Treatment Outcome; D015430:Weight Gain
chemical_list: D004044:Dietary Proteins; D012709:Serum Albumin