PHYSICIANS IMPLEMENTATION OF DIETITIANS RECOMMENDATIONS - A STUDY OF THE EFFECTIVENESS OF DIETITIANS

Objective To determine how often dietitians' recommendations were impl emented by physicians and to identify workplace and demographic factor s that correlated with successful implementation of recommendations. D esign A cohort of hospitals was surveyed by mail. Dietitians recorded recommendations written in five consecutive medical record entries and sent them to the chief clinical dietitian. Seventy-two hours later, p hysicians' order sheets were reviewed to assess implementation. Dietit ians completed demographic questionnaires. Subjects Forty-four general hospitals in Philadelphia and the surrounding area were surveyed. To ensure similar standards of nutrition care, only hospitals approved by the Joint Commission on Accreditation of Healthcare Organizations wer e selected. Statistical analysis performed chi(2), Fisher's exact test , and the Kruskall-Wallis test were used to correlate demographic vari ables with implementation rate. Main outcome measure Implementation of the dietitians' recommendations by physicians' orders. Results Respon ses were obtained from 35 of the 44 hospitals and 98 (70%) of the clin ical dietitians. Of the 865 recommendations, 42% were implemented. Sig nificantly higher implementation rates were noted for recommendations solicited by (50%) or discussed with the physician (65%). Dietitians w ere more successful in teaching hospitals and when they reported to a hospital-operated foodservice rather than a contract foodservice: Succ ess correlated with a lower workload when measured by the ratio of adm issions to staff but not when measured by the ratio of beds to staff. Conclusions Dietitians could have a greater effect on nutrition care b y discussing recommendations with physicians. Further research is need ed about staffing formulas and methods to improve the effectiveness of dietitians.