CURRENT LITERATURE

Objective: To determine if patient nutrition acuity accurately predicts the time required to perform medical nutrition therapy (MNT). Design: Data detailing demographic characteristics, patient nutrition acuity, and time spent performing AINT were collected for 12 consecutive days. Random systematic sampling was used to select 25'10, or a minimum of 20 patients, from daily admissions to the hospital. Nutrition acuity was categorized using a 27-item patient acuity tool. SubjectslSetting: Analysis included data from 92 acute-care hospitals nationwide; the median census was 271 patients: Of the 7,289 patients in the survey, 3,321 were included in this data analysis. All subjects were assigned an acuity rating and received BINT. hlean age ( 2 standard deviation [SD]) was 55 2 24 years, and the sample was 48% male and 52% female. Time spent delivering AINT ranged from 5 to 285 minutes (mean ? SD = 43.3 2 34.2 minutes). Statistical A ~ i a l p ~ s Performed: Stepwise multiple regression analysis (P < .05), with independent variables of age, gender, and 27 acuity descriptors, determined time required to perform MNT. Results: The number of acuity descriptors assigned to patients ranged from zero (53 patients) to 20 (1 patient); the mean ( 2 SD) for all patients was 5.6 2 3.1. Gender and 21 of the 27 acuity descriptors were statistically significant in predicting the time required to perform hINT. ApplicationslCoiiclusions: A formula was developed to determine medical nutrition therapy time (AIN'IT) as minutes per patient sampled. When extrapolated to a facility's patient census, hINTl' is the basis for predicting staffing requirements. The hINTT formula is crucial in the present environment of managed care where fiscal accountability challenges staffing rationales. (J Am Diet Assoc 99:1367-1372, 1999) COMMENT: Health care facilities have been under pressure to reduce costs at a time of increasing paticnt acuity. One measure by which cost reduction has been accomplished is reduction of staff. Documenting the time required for adequate delivery of care is a crucial step in determining appropriate levels of staffing. Quantifying dietitian staffing needs has proved especially difficult. Not every patient needs medical nutrition therapy (RZNT), and therefore indirect indicators such as patient census, diet orders, and patient diagnoses do not predict dietitian workloads well. To address this problem, the Clinical Nutrition Management dietetic practice group of The American Dietetic Association developed a Patient Acuity Tool that would predict the amount of RlNT needed. The current study testcd this tool and used the data obtained to develop a formula to predict the amount of hINT time (RINTT). hIN" calculated with the prcdictivc formula is supported by previous research. For example, the RIN'M' analysis indicates that 11.9 minutes is needed for initial patient assessment and classification; similar procedures are reported in the literature to requirc from 5 to 7 minutes to 10.5 minutes. The hlNTT is limited by the fact that i t focuses only on patient care and does not includc administrative or other responsibilities. However, it provides an objective tool by which clinical nutrition managers can evaluate staffing needs and link this to qualitj of care. Genie Moore, RN, RD, PhD Randomised Controlled Study of Clinical Outcome Following