A patient-centered foodservice model, such as room service, can improve patient nutritional intake and enhance patient satisfaction in a budget constrained health care environment.

This research provides insight into the benefits achievable with RS in the public hospital setting, confirming that a patient-centred food service model can cost-effectively improve clinical outcomes.

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Aim Poorly controlled gestational diabetes mellitus can result in negative pregnancy and delivery outcomes. A reduced need for insulin was documented in the validation of American gestational diabetes Nutrition Practice Guidelines, which recommend at least three dietitian visits. No Australian gestational diabetes mellitus nutrition guidelines exist. This paper evaluates the implementation of a dietetic model of care based on the American guidelines in an Australian hospital. Methods The implementation plan consisted of a nine‐month pre (usual care)/post (new model of care) design with a month for ‘integration’ across 2012–2013. Primary outcomes were uptake of the new dietetic model of care and requirement for pharmacotherapy. Results Both phases ran for seven months; integration required four months. Pre‐intervention, only one woman received a review appointment. Significantly more women received best‐practice care post‐implementation (P = 0.02); of the 162 women seen, 50.6% received two review appointments. As a result of heavy clinical demand, only 31.5% of the women seen post‐implementation received an individual dietitian assessment and education session, deviating from best practice. Clinically relevant changes were seen in medication requirements with a decrease in women requiring pharmacological treatment (31.1% (pre); 26.9% (post)). The difference was more pronounced in women who received best‐practice care (27.2% (no) vs 25.0% (yes)). Conclusions This project successfully increased the proportion of women seen according to best practice. Service limitations impaired the delivery of optimal care. The present study illustrates the opportunities and challenges of conducting evidence‐based implementation research in routine clinical care.

Reduced insulin requirements and improved blood glucose level (BGL) control in gestational diabetes mellitus (GDM) have been documented in a study validating American Nutrition Practice Guidelines that included a dietitian appointment schedule. No Australian nutrition practice guidelines exist and care differs across centres. Guideline dissemination alone does not change practice; assessment of barriers/enablers and implementation design must be theory‐driven. We describe this assessment and the planned intervention to implement a schedule of dietitian consults for GDM care. A barriers and enablers analysis was undertaken. Data sources included hospital records, clinic observation, and staff surveys. Dietetic visits were compared with the Nutrition Practice Guideline. Barriers were categorised into domains from the Theoretical Domains Framework. Of 44 clinic staff surveyed, most believed regular dietetic contact could influence diet, but fewer believed contact could influence BGLs, pharmacotherapy, and care costs, and only half felt contact could influence weight gain or macrosomia. Women's lack of awareness of the benefits of scheduled contact with a dietitian and staff's unfamiliarity with current practice were identified. There was a significant shortfall in dietitian resources. Other barriers included lack of dedicated clinic space and exclusion from the clinic care pathway. Identified barrier ‘domains’ were: Knowledge; Beliefs about consequences; Intentions; Social/professional role/identity; Social influences; Memory, attention, and decision processes; and Environmental context and resources. Effective change interventions have been mapped to domains. Outcomes of the evaluation will be uptake of the new dietetic schedule and its effect on requirement for pharmacotherapy. Copyright © 2014 John Wiley & Sons. Practical Diabetes 2014; 31(2): 67–72