Registered Dietitians Boost Patient Outcomes — and Providers’ Financial Health
Back when I worked as a registered dietitian in a hospital, I became acquainted with a patient whose readmission rate was off the charts. He had a history of congestive heart failure, and there was a general consensus that convincing him to take better care of his condition, particularly when it came to nutrition, was next to impossible.
Well, I thought, I can try.
Granted, I was new to the career and like many young professionals, I still believed I could change the world. But the great thing about working in healthcare is that at the very least, you can change individual lives.
So, I chatted with him to gain a better understanding of his life situation. He didn't know how to cook, and had neither the time nor interest to learn, which meant he was dining out nearly 100% of the time — a surefire recipe for consuming too much sodium. We talked about healthier retail food options, how to select items from the menu that were lower in salt and fat, and strategies to be more compliant with his medication. It was a matter of figuring out the lifestyle changes that would genuinely work for him, and why those changes were important. He told me that at last it all finally made sense. While his readmission rate never reached zero, it did vastly decrease.
Not to be cliché, but an ounce of prevention really is worth a pound of treatment — and that's exactly where registered dietitians (RDs) come in. Most people don't realize how critical their food choices are to improving or damaging their well-being, and even some clinicians don't fully appreciate how important nutrition is in the healthcare environment. Considering that March is National Nutrition Month, and March 8 is National Registered Dietitian Nutritionist Day, it seems like a perfect time to delve into how dietitians benefit patient outcomes — and how they can even boost providers' financial health.
Reducing Length of Stay and Readmissions
As the story I just told illustrates, food plays an important role in reducing hospital readmission rates, especially for chronic illnesses such as diabetes, high cholesterol, congestive heart failure and hypertension. For instance, to reduce or even halt hypertension, dietitians often educate patients about the DASH diet, which stands for “Dietary Approaches to Stop Hypertension.” DASH encourages foods that are rich in potassium, calcium and magnesium (which help control blood pressure) while limiting foods that are high in sodium, saturated fat and added sugars. Studies have shown that DASH can quickly lower blood pressure, along with LDL (or “bad”) cholesterol — decreasing two of the major risk factors for heart disease and stroke.
By helping patients improve their health via adjustments to their nutritional intake — which, in addition to eating, can occur through initiation and monitoring of tube feeding or intravenous administration — dietitians simultaneously decrease many of the financial burdens on health organizations that are caused by increased length of stay (LOS) and readmissions. This is especially important as Vizient subsidiary Sg2's Impact of Change forecast projects hospital resources will experience even greater strain due to a rise in patient acuity over the next decade that will outpace inpatient volume and impact patient length of stay. Fueled in part by COVID-19 and its lingering effects, healthcare organizations can potentially expect an increased number of patients with more complex conditions creating capacity constraints that may require new strategies for patient care delivery.
According to the report, hospital inpatient days are expected to increase at 8% growth — largely fueled by the kind of chronic diseases that can often be at least partially mitigated by proper nutritional guidance. By making the relatively small investment required to hire more dietitians (the U.S. Bureau of Labor Statistics estimates the mean annual wage for an RD is $65,620), hospitals can save far more money in the long run. A study by investigators from Brigham and Women's Hospital, in collaboration with investigators at the Friedman School of Nutrition Science and Policy at Tufts University, found that suboptimal diet costs approximately $300 per person, or $50 billion nationally (84% of which is due to acute care). And as noted in a previous blog, RDs play a key role in ensuring patients with pressure injuries or other type of wounds receive the proper nourishment to not just recover but thrive, with the prevention of just three Stage III pressure injuries equating to the annual cost of a registered dietitian's salary.
Of course, the benefit of collaborating with dietitians extends beyond the hospital walls. RDs who work in the community can provide vital education and resources for patients with chronic conditions. Nutrition is not something to just consider at a point of illness — collaboration in the non-acute environment reduces the frequency of hospital admissions. It also has significant economic benefits for patients, as one in three Americans with chronic illness has trouble affording food, medication or both, and food insecure people in the U.S. on average incur an extra $1,800 in medical costs every year, accounting for $77.5 billion in additional healthcare expenditures.
Influencing Procurement Practices
Healthcare organizations supply more than $100 billion of food each year to patients, many of whom represent the most vulnerable populations these facilities serve. Despite the obvious advantages for patients and hospitals, RDs are often left out of menu decisions in the food service operation. Hiring a food service manager who is a registered dietitian means they can help plan, order and implement menus that are nutritious while navigating procurement of products that are more environmentally friendly. Locally sourced food, for example, is more budget-friendly due to decreased cost of storage, shipping, packaging and refrigeration. RDs also can help health organizations avoid food packaging with intentionally added polyfluoroalkyl substances (PFAS) — which is especially important as more U.S. states have adopted prohibitions and restrictions of products containing PFAS.
Fully Integrate RDs into Patient Care
Registered dietitians are publicly trusted sources of nutrition knowledge, and it's crucial that healthcare organizations involve them in process and quality improvement projects if they have not already. Some ways to do so include:
- Early initiation of enteral nutrition in the ICU: This reduces mortality, pneumonia, length of stay and risk of infection, and in non-critically ill hospitalized patients, early enteral nutrition significantly reduces infectious complications. It also reduces healthcare resource consumption and total costs, with some studies showing a reduction of $14,462 per patient in total acute care costs.
- Nutrition-focused physical exams: NFPE is the gold standard for determining malnutrition and its severity in patients. The days of using a lab test are long gone. By recognizing malnutrition in patients, the hospital may use the corresponding malnutrition code for reimbursement.
- Involve RDs in interdisciplinary rounds: An interprofessional team approach to clinical rounds allows each member to boost patient outcomes through their individual expertise. One recent study noted that it also results in consistency of practice. If, for example, a team member cannot make rounds, others could step in to advocate for the patient. For instance, a dietitian could suggest a patient-specific insulin regimen or parenteral prescription.
- Consider letting RDs actively manage nutrition support: Often, other clinicians such as nurses, pharmacists and physicians are tasked with identifying the need for and monitoring nutrition support while the RD has a more passive role, even though nutrition education in nursing, pharmacy and medical schools is not nearly at the level of that provided to dietitians. Dietitians are better able to tailor individualized nutrition support plans, and monitor and evaluate tolerance and other outcomes related to intervention strategies, to achieve the desired nutritional and patient-safety objectives.
Don't forget: Food is medicine.
Barb Mueller, Vizient senior program services manager, also contributed to this blog.