care, yet only had 20 registered dietitians (RDs) to provide nutritional care to the almost 800 patients per day and 42,500 admissions in fiscal year 2011. HUP has a 2014 goal of eliminating preventable deaths and 30-day readmissions, and achieving both requires all hospital employees, including RDs, to focus on the same goals.

The Role of RDs in Hospital Readmissions

In order to achieve its 2014 goal of eliminating 30-day readmissions, HUP will address the factors that predict hospital readmissions, such as those identified in Box 3-1.

There is a growing body of research demonstrating that dietitians can help prevent hospital readmission by providing nutrition counseling that changes patients’ behaviors and improves clinical outcomes. Studies have shown that RD counseling can result in weight loss (Raatz et al., 2008), improved weight management and lipid profiles (Gaetke et al., 2006; Welty et al., 2007), sustained heart-healthy diet modifications (Cook et al., 2006), and adherence to a low-sodium diet in patients with heart failure (Arcand et al., 2005). Implementation of recommendations for enteral tube feeding in long-term acute care facility patients resulted in shorter lengths of stay, improved albumin levels, and desired weight gain (Braga et al., 2006). Compher highlighted an “intriguing study” conducted by Feldblum and colleagues in Israel among adults age 65 years and older. Feldblum et al. (2011)

BOX 3-1
Factors that Predict Hospital Readmissions

Utilization Factors

•  Longer length ot stay

•  Prior admission(s) in the past year

•  Previous emergency department visits

Patient Characteristics

•  Comorbidity (diabetes mellltus. hypertension, congestive heart failure, chronic kidney disease, depression)

•  Living alone

•  Discharged to home

•  Medicare/Medicaid

SOURCE: Leas and Umscheid, 2011.

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