title: Predictors of dietitian consult on medical and surgical wards.
abstract: OBJECTIVE
  Guidelines promote dietitian consult (DC) for nutrition support. In Canada, dietitians are involved in the assessment of malnutrition and provide specialized dietary counseling. It is unknown however, what leads to a DC for patients fed orally. This study identifies independent predictors for a DC and determines what is the proportion of malnourished patients seeing a dietitian.
  
  
  METHODS
  The Canadian Malnutrition Task Force conducted a prospective cohort study in medical and surgical wards of 18 Canadian hospitals. 947 patients who did not receive enteral or parenteral nutrition were analyzed. At admission, subjective global assessment (SGA), body mass index, patient demography were collected. During hospitalization clinical data, including dietary intake and presence of a DC were obtained. Multivariate logistic regression was completed with dietitian consult ≤ 3 days and 4 + days as the outcome variables.
  
  
  RESULTS
  The prevalence of malnutrition (SGA B + C) was 45%. Dietitians were consulted for 23% of patients, and of these consults 44% were well nourished (SGA-A), 37% were mildly/moderately malnourished (SGA-B), and 19% were severely malnourished (SGA-C). DC missed 75% of the SGA-B and 60% of SGA-C patients. Predictors of consultation within 3 days of hospitalization were: renal diet (OR 5.75) modified texture diet (OR 5.38), metabolic diagnosis (3.91), ONS use pre-admission (OR 2.33), severe malnutrition (SGA-C, OR 1.88) and age (OR 0.98). Predictors for 4 + days were: dysphagia (OR 11.4), a new medical diagnosis (OR 2.3), severe malnutrition (OR 2.17), constipation (OR 2.16), more than one diagnosis (OR 1.8), antibiotic use (OR 1.6), and male gender (OR 1.6). Consuming < 50% of food in the first week was not a predictor as only 19% of those with low intake had a DC at 4 + days.
  
  
  CONCLUSIONS
  Overall predictors of DC were appropriate but SGA B and C patients and those eating <50% were missed. Screening at admission with algorithms of care that include referral to the dietitian are needed to improve the process of nutrition care.
authors.affiliation: Schlegel-UW Research Institute for Aging, University of Waterloo, 200 University Avenue, West Waterloo, ON, N2L 3G1, Canada. Electronic address: hkeller@uwaterloo.ca.
authors.forename: Heather
authors.initials: H
authors.lastname: Keller
authors.affiliation: Department of Medicine, Division of Gastroenterology, Toronto General Hospital, 585 University Avenue, 9N-973, Toronto, ON, M5G 2C4 Canada.
authors.forename: Johane P
authors.initials: JP
authors.lastname: Allard
authors.affiliation: Reseau de sante Vitalite Health Network, Campbellton Regional Hospitals, 189 Lily Lake Road, PO Box 880, Campbellton, NB, E3N 3H3, Canada.
authors.forename: Manon
authors.initials: M
authors.lastname: Laporte
authors.affiliation: 788 Avondale Avenue, Kitchener, ON, N2M 2W8, Canada.
authors.forename: Bridget
authors.initials: B
authors.lastname: Davidson
authors.affiliation: Université de Sherbrooke, Research Center on Aging, CSSS-IUGS, 1036, Belvedere Street, Sherbrooke, QC, J1H 4C4, Canada.
authors.forename: Helénè
authors.initials: H
authors.lastname: Payette
authors.affiliation: Jewish General Hospital, 3755 ch Cote Ste-Catherine, Montreal, QC, H3T 1E2, Canada.
authors.forename: Paule
authors.initials: P
authors.lastname: Bernier
authors.affiliation: Department of Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
authors.forename: Khursheed
authors.initials: K
authors.lastname: Jeejeebhoy
authors.affiliation: Department of Medicine, Division of Gastroenterology, C5120 409 Tache Avenue, St. Boniface Hospital, Winnipeg, MB R2H 2A6, Canada.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Duerksen
authors.affiliation: University of Alberta, Division of Gastroenterology, Room 214, Community Services Centre, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada.
authors.forename: Leah
authors.initials: L
authors.lastname: Gramlich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002170:Canada; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D018529:Nutritional Support; D064686:Nutritionists; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000175:diagnosis*; D012017:Referral and Consultation
keywords: Acute care; Consult; Malnutrition; Registered dietitian