Importance of Building a Team

As a new resident physician, you are tasked with long days and the responsibility of learning how to analyze variances and subtle changes in lab tests, vital signs, diagnostics and much more. 

Developing a team approach can be a life-saver in your days as a resident. Each member of the team has special training in their area of expertise to help your learning curve.  

The interdisciplinary team can include:

·         Nurses

·         Pharmacists

·         Physical Therapists

·         Speech Therapists

·         Dietitians

·         Respiratory Therapists

·         Social Workers

 

How Can A Dietitian Help You In Your Practice?

A resident’s time is increasingly pressured to do more with less. Burnout is a real thing.  As a clinical dietitian (RD) for over 18 years, I have learned a thing or two about helping doctors develop the best plan of care, which ultimately can reduce demands on their time. 

Maybe even more importantly, a patient’s time spent with a dietitian may help speed a patient’s recovery and healing, saving the hospital money, improving the health of the patient, and making an ever-increasingly tight budget more manageable. 

Here are a few reasons to reach out to your hospital’s dietitians. This even extends well into the clinic setting. 

They know tube feedings and total parenteral nutrition inside and out

RD nutritionists are trained to assess a patient’s nutritional needs and can write tailored orders for nutrition support. They can make recommendations for when nutrition support is indicated. Some RD’s even have advanced practice training in nutrition support.

They know the vitamin and mineral formulary

I have had many discussions with resident doctors at my hospital and the bottom line: they don’t have time to investigate what supplements are available and when to use them, which kinds are most absorbable, etc. 

 

Your dietitians should be able to quickly share this with you or make recommendations. Even better, develop a rapport with the dietitian, and they will be able to obtain standing orders for these.

They can help increase Medicare reimbursements for malnutrition

How?  By helping with accurate diagnosis of malnutrition.  Patients who are malnourished are reimbursed at a higher rate through Medicare because they have higher morbidity and mortality.  However, the coding and wording of diagnoses needs to be done in a very specific way that RD’s know and are trained to do correctly.

Malnutrition Trivia:

Did you know that it is not only alcoholics risk the permanent damage of thiamine deficiency?  Malnutrition and gastric bypass often result in thiamine deficiency and that can cause Wernicke’s encephalopathy too.  Sugar addicts also run low on thiamine.

They are helping change the way perioperative feeding practices

At my facility, we have an amazing team of doctors and nutritionists.  Colleagues of mine have been integral along with the surgeons in starting a perioperative nutritional program.  Improved feeding practices in the perioperative period have resulted in reduced infections and dramatic reductions in length of stay http://www.espen.org/files/ESPEN-guideline_Clinical-nutrition-in-surgery.pdf .  In other words, evidence supports pre-operative nutrition assessment and feeding as well as post-operative early nutrition.  The RD is essential in helping these processes run well.

Nutrients may speed wound recovery and healing

A great nutritional plan at the time of admission for patients with trauma or wounds may speed healing and recovery time https://www.ncbi.nlm.nih.gov/pubmed/27574687

 https://www.ncbi.nlm.nih.gov/pubmed/16998143

https://www.ncbi.nlm.nih.gov/pubmed/17490965

Nutrients may improve functional recovery, especially in the elderly hospitalized patient

Many studies show that early intervention for supplements in elderly patients may reduce hospital costs and improve functional recovery. This may even reduce mortality https://www.ncbi.nlm.nih.gov/pubmed/1452950

https://www.ncbi.nlm.nih.gov/pubmed/19370584

https://www.ncbi.nlm.nih.gov/pubmed/28231616

Drug-nutrient interactions:

Many common drugs on the market today, if taken for long periods of time, rob the body of key nutrients for immunity and healing.  Corticosteroids, ARBs and ACE inhibitors, Methotrexate, chemotherapy drugs, and metformin are just a few of these. Your RD can help identify and make additions nutritionally to help the patient achieve the best chance of recovery. As a resident, make sure you inquire about drug-nutrient interactions.

Condition-related depletions

Conditions like Crohn’s, chronic diarrhea, heart failure, and even diabetes are notorious for causing nutrient-related complications. Ask your RD to help you ameliorate some of these issues.

 Education

Educating and motivating patients takes a lot of time; your RDs can help with this.  RDs are trained to motivate behavior change for diabetes, heart disease, depression, cancer treatment.  Some even specialize in depression, autoimmunity, integrative medicine and many more.

Cancer treatment side effects

Keeping patients well-nourished through cancer treatment will help keep them out of the hospital and will improve chances of survival and best outcomes. Your RD can help tackle malnutrition in this vulnerable population. 

Closing Thoughts

RDs are an important resource for resident physicians in the hospital; when working together, they can help improve your learning experience, patient recovery and save precious hours in the day.  A team-building approach will be beneficial to you in your career as a resident.  If you can develop a rapport with the therapy team, you will increase your understanding of the healing process.

 

 

Heidi Moretti, MS, RD has worked as a clinical nutritionist for 18 years and has conducted vitamin and protein research throughout her career. She is passionate about integrative and functional nutrition and is obtaining certification through the Integrative and Functional Nutrition Academy. She is a blogger and also has a private practice; you can find her on TwitterFacebookPinterest and her website: https://www.dietdetectiverd.com/