Hand Rosa K, Lamers-Johnson Erin, Jimenez Elizabeth Yakes, Steiber Alison L
Department of Nutrition, Case Western Reserve University, Cleveland, Ohio.
Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois.
J Acad Nutr Diet. 2025 Mar;125(3):348-365. doi: 10.1016/j.jand.2024.08.006. Epub 2024 Aug 22.
More data are needed to guide evidence-based, inpatient registered dietitian nutritionist (RDN) staffing models.
Identify relationships between: 1) patient malnutrition risk or intervention categories and estimated total RDN care time ("care time"); and 2) care time and emergency department (ED) visits.
This study was a prospective cohort study with data collection via RDN surveys, patient interviews, and medical record review.
PARTICIPANTS/SETTING: Adult (n = 550) and pediatric (n = 345) patients enrolled at 32 adult and 27 pediatric US hospitals from August 2019 to January 2023.
Care time and ED visits within 90 days of hospital discharge were measured.
Multilevel, generalized linear, and negative binomial regression models were used to evaluate relationships between patient characteristics and Box-Cox-transformed care time and the relationship between Box-Cox-transformed care time and total ED visits.
After adjusting for patient characteristics, adult patients classified as at malnutrition risk vs not at risk required a mean of 8% (95% CI 5% to 11%) more care time. Pediatric patients at medium or high compared with low malnutrition risk needed a mean of 21% (95% CI 4% to 40%) and 31% (95% CI 12% to 54%) more care time, respectively. Number of initial RDN interventions categories per patient (0 to 1 vs 2 to 3 or 4+) was associated with a mean of 10% (95% CI 7% to 14%) or 8% (95% CI 2% to 15%) more care time for adults and 17% (95% CI 5% to 32%) and 39% (95% CI 21% to 61%) more care time for children, respectively. More estimated total RDN care time was associated with significantly higher incidence rate ratios of ED visits (adults: incidence rate ratio 2.8; 95% CI 1.1 to 7.2; children: incidence rate ratio 1.7; 95% CI 1.02 to 2.8).
Patient malnutrition risk or breadth of nutrition interventions required can inform nutrition department staffing. Intervention studies may better define relationships between care time and medical outcomes.
