Windle E M
Department of Nutrition & Dietetics, Pinderfields General Hospital, Wakefield, West Yorkshire, UK.
J Hum Nutr Diet. 2009 Aug;22(4):317-23. doi: 10.1111/j.1365-277X.2009.00965.x. Epub 2009 May 26.
Catabolism and lean body mass losses in severe burn injury present an extreme challenge to the dietitian. A high level of nutritional intervention is often required, but service levels have not been described in the UK. This study aimed to identify levels of current dietetic services with respect to burns and to assess adequacy against existing nutrition support standards.
A postal survey of 34 UK dietetic departments known to provide care to burned adult and paediatric admissions was undertaken. Data were collected on burns settings, hospital service characteristics, staffing and caseload issues, and absence cover. Comparison was made between funding and activity to National Health Service standards for the nutritional care of inpatients.
The response rate was 71% and data were analysed for 20 departments Clinical settings were either burn units or plastic surgery wards. Dietetic care was provided to critically ill burned patients in 16 hospitals. Most hospitals had no dietetic funding assigned for burn care. The funding deficit for critical care compared to recommendations was 5.9 full-time equivalents and no individual hospital met funding standards. Thirty-seven percent of dietitians were unable to provide daily follow up for critically ill patients. Absence cover was limited in 60% of cases. Approximately one-third of dietitians were members of a nutrition support team.
Compared to national guidelines for nutrition support, deficiencies of dietetic service provision exist within UK burns settings. This is further reinforced when practice is compared with existing multi-professional burns management standards.
严重烧伤患者的分解代谢和瘦体重丢失给营养师带来了极大挑战。通常需要高水平的营养干预，但英国尚未描述相关服务水平。本研究旨在确定当前烧伤营养服务水平，并根据现有营养支持标准评估其充足性。
对英国34个已知为烧伤成人和儿童患者提供护理的营养科进行了邮寄调查。收集了烧伤科室、医院服务特征、人员配备和病例量问题以及缺勤替代等方面的数据。将资金和活动情况与英国国家医疗服务体系住院患者营养护理标准进行了比较。
回复率为71%，对20个科室的数据进行了分析。临床科室为烧伤病房或整形外科病房。16家医院为重症烧伤患者提供了营养护理。大多数医院没有为烧伤护理分配营养资金。与建议相比，重症护理的资金缺口为5.9个全职等效人员，没有一家医院达到资金标准。37%的营养师无法为重症患者提供每日随访。60%的情况下缺勤替代有限。约三分之一的营养师是营养支持团队的成员。
与营养支持国家指南相比，英国烧伤科室的营养服务存在不足。与现有的多专业烧伤管理标准相比，这种不足更加明显。
