Physicians' implementation of dietitians' recommendations: a study of the effectiveness of dietitians.
OBJECTIVE: To determine how often dietitians' recommendations were implemented by physicians and to identify workplace and demographic factors that correlated with successful implementation of recommendations. DESIGN: A cohort of hospitals was surveyed by mail. Dietitians recorded recommendations written in five consecutive medical record entries and sent them to the chief clinical dietitian. Seventy-two hours later, physicians' order sheets were reviewed to assess implementation. Dietitians completed demographic questionnaires. SUBJECTS: Forty-four general hospitals in Philadelphia and the surrounding area were surveyed. To ensure similar standards of nutrition care, only hospitals approved by the Joint Commission on Accreditation of Healthcare Organizations were selected. STATISTICAL ANALYSIS PERFORMED: chi 2, Fisher's exact test, and the Kruskall-Wallis test were used to correlate demographic variables with implementation rate. MAIN OUTCOME MEASURE: Implementation of the dietitians' recommendations by physicians' orders. RESULTS: Responses were obtained from 35 of the 44 hospitals and 98 (70%) of the clinical dietitians. Of the 865 recommendations, 42% were implemented. Significantly higher implementation rates were noted for recommendations solicited by (50%) or discussed with the physician (65%). Dietitians were more successful in teaching hospitals and when they reported to a hospital-operated foodservice rather than a contract foodservice. Success correlated with a lower workload when measured by the ratio of admissions to staff but not when measured by the ratio of beds to staff. CONCLUSIONS: Dietitians could have a greater effect on nutrition care by discussing recommendations with physicians. Further research is needed about staffing formulas and methods to improve the effectiveness of dietitians.