Mr Nicholas Van Veenendaal1, Ms Bridget Agius1, Ms Hilda Griffin1
1Melbourne Health, Melbourne, Australia
Aim
To explore the clinical prioritisation of dietetics referrals for outpatients in Victorian Hospital Nephrology services
Background
The KDOQI Clinical Practice Guideline for Nutrition recommend medical nutrition therapy across all stages of kidney disease and post transplantation to optimise nutrition status. Nutrition requirements are varied depending on the stage of kidney disease, and presence of other co-morbidities. Access to dietetic services is inconsistent and clear criteria for clinical prioritisation is lacking. Effective triaging of referrals ensures timely access to nutrition care for patients most at risk.
Methods
A benchmarking survey was distributed via email to renal dietitians working in Victorian public health services. Participants ranked 11 dietetic referral indications based on their local renal nutrition ambulatory services. Options included a priority rating of 1-3 (with 1 being the highest clinical prioritisation and 3 the lowest) and ‘unlikely to be seen’. Qualitative data relating to the triage process were also collected.
Results
The response rate to the survey was 53% (n=8). Malnutrition and hyperkalaemia were most frequently rated as priority 1 (75%), with the lowest priority rating given to pre-transplant education (25% as Priority 3 and 75% as unlikely to be seen). Other referral indicators for therapeutic diet educations were ranked across all domains with low agreement between health services. Subjective data noted that a patients overall clinical presentation informs referral prioritisation (50%) and resource limitations are a barrier for access to nutrition service (50%).
Conclusions
Dietetic prioritisation of nutrition needs for patients with kidney disease in ambulatory care was broadly consistent across services. A comprehensive evaluation of service delivery including barriers and facilitators to access to care may better inform future service innovations.
Biography:
Bio to come