Monongalia General Hospital is an 189 bed acute-care community hospital and level 4 West Virginia trauma center. With only 2 FTE clinical dietitians working each day, it’s impossible (and unnecessary) for a dietitian to visit every patient in the hospital. But who gets to the see a dietitian, and how is that decided? While it may be different at other hospitals, this is the consult system Mon Gen uses:
1- A physician or nurse orders a consult. This could be because the physician feels the patient needs nutrition education, the patient is high-risk, or any reason they see fit.
2- A system consult is automatically ordered. On a patient’s chart, there is a section with several boxes of criteria. If one or more of these criteria is met, the charting system automatically orders a consult. The criteria include unintentional weight loss of more than 10 pounds in 3 months, constipation, bed sores, and more.
3- The patient meets nutrition screening criteria. Dietitians can see patients that meet a specific diagnosis and/or treatment with component of nutrition therapy, including but not limited to:
- Malnutrition, cancer, undergoing chemotherapy, radiotherapy, major surgery, oncology unit patient
- Newly diagnosed diabetes mellitus, or uncontrolled
- Unstable chronic renal disease
- Unstable liver disease
- GI: Crohn’s disease, ulcerative colitis, short bowel syndrome, GI fistula, small bowel obstruction
- Failure to thrive
- CVA (cerebrovascular accident or stroke) with severe dysphagia
- Significant education needs
When these methods of ordering a consult with a dietitian are used, clinical dietitians are able to use their time wisely to see the patients who need the most help.