Practice Applications

Professional Practice

Analyzing Registered Dietitian Nutritionist Productivity Benchmarks for Acute Care Hospitals

Background

Two national RDN productivity benchmark studies were conducted in 2014 and published in 2015 to contribute to the literature as it relates to the commonly asked question of the recommended ratio of RDN FTEs to patient census, based on a variety of factors.1, 2

The Academy of Nutrition and Dietetics (Academy) created a workgroup in 2014 with members from the Clinical Nutrition Management Dietetic Practice Group and the Dietetics Based Practice Research Network (now called the Nutrition Research

RDN Productivity Measurement

As many hospitals face financial challenges, RDN productivity benchmarks remain a priority focus area to justify existing staff or support a business case for adding additional RDN FTEs when new hospital services or patient care floors are added. Hospital administrators responsible for budget decisions require RDN time to be measured rather than assumptions made. Despite the quality of previously published data by MHC and the Academy’s NRN workgroup, additional questions remained to be

Evaluation Process

The feasibility of standardizing productivity monitoring and reporting benchmarks in multiple facilities across the country had already been established in the 2014 MHC staffing benchmark study.² In 2017, this same productivity monitoring form was used, with new data fields added to collect additional data and determine additional benchmarks. Fewer facilities were recruited for this study, due to the increased amount of data and time required to collect and analyze it, thus ensuring the

Evaluation Results

RDNs spent an average of 84% of their time providing the direct care activities described in the Figure, with 16% of their time spent on indirect care activities. On average, a comprehensive assessment required 40 minutes of RDN time, while a limited assessment required 22 minutes. Seventy-four percent of assessments were classified as comprehensive.

Since some RDNs work fewer than 8 hours per day, and others work more than 8 (such as those who work four 10-hour days), the average number of

Interpretation of Results

Because health care has changed due to provisions in the Accountable Care Act and other payment models,⁶ there is a strong emphasis on avoiding admitting patients to the hospital if possible. Therefore, acute care hospitals generally provide a higher complexity of care. This is reflected in the fact that 74% of nutrition assessments were comprehensive encounters, and required 40 minutes of RDN time on average.

The time spent in screening and prioritizing patient lists was very similar to that

Potential Application of Results

The benchmarks reported in this article have several applications. Some hospitals may choose to use them for forecasting and planning for RDN staff that may be needed when adding a new service or opening a new patient care floor. Hospital administrators planning facility-wide budgets are usually unfamiliar with the methods that trigger a nutrition assessment by an RDN, and may make the erroneous assumption that either 100% of patients are seen by RDNs or that it is a consult-only service. The

Utilizing Reported Benchmarks

There are limitations associated with this study. The data are self-reported; therefore, the same limitations exist as with any self-reported data in any study. There is a risk of over- or underreporting or mistakes in reporting. This is not a pure adult or pure pediatric sample; however, this reflects real-world situations as there are very few hospitals that do not have at least a few pediatric beds for emergency situations or stabilizing children until they can be transported to a higher

Conclusion

This study reports on some of the same RDN productivity benchmarks previously published and provides additional benchmarks for the literature. The results should be viewed with the lens of the stated limitations, particularly that the ideal RDN staffing ratio with a national standard model has yet to be determined until patient outcomes can be associated with RDN staffing levels. Future supplementary studies would differentiate the time required to provide care by specialized RDNs, such as

Acknoweldgements

The authors acknowledge and thank all RDNs who contributed data to this study.