Ward-based dietitian integration improves nutritional care in gastroenterology inpatients

Introduction: The organization of clinical dietetic services varies across healthcare systems and may be centralized (often by referral, where dietitians serve multiple wards) or decentralized, where a dietitian is embedded within a single ward team. Limited evidence exists comparing different organizational structures of clinical dietetic services and their impact on nutrition care delivery and patient outcomes. The aim of this study was to evaluate whether integrating a dedicated clinical dietitian into a medical gastroenterology ward improves the quality of nutrition care and patient outcomes compared to a by-referral model. Materials and methods: A retrospective quality assurance study compared nutritional care and patient outcomes before and after implementation of a ward-based dietitian model in a medical gastroenterology ward. Medical record audits were conducted for all inpatients admitted during August–September 2020 (by-referral model) and August–September 2021 (ward-based model). Results: A total of 128 patients were included (74 by-referral; 54 ward-based). Nutritional risk screening increased from 18% to 83% (p < 0.01) and documentation of dietary intake from 34% to 59% (p < 0.01). Dietitian consultations increased from 11% to 68% (p < 0.01). Provision of nutritional therapy increased (10% to 22%, p = 0.04), and in-hospital weight loss of ≥5% decreased (22% vs. 7%, p = 0.01). Conclusions: Embedding a clinical dietitian within a ward team improved the identification of nutritional risk, the documentation of intake, and the delivery of nutrition interventions and reduced in-hospital weight loss. These findings support the value of ward-based dietitians in strengthening hospital nutritional care and patient outcomes.