Extended roles and the dietitian: community adult enteral tube care

Stanley, Weena; Borthwick, Alan

doi:10.1111/jhn.12016

Cited by 13 publications

(23 citation statements)

References 33 publications

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“…However, there is little engagement through training or career progression in extended scope of practice. In the UK and America, a range of ESP positions exist for dietitians; including roles in stroke management, gastroenterology and outpatient enteral feeding [ 10 – 12 ]. Although a variety of extended scope of practice roles for dietitians are identified in the literature, few studies have focused on evaluating these roles [ 10 , 12 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

“…In the UK and America, a range of ESP positions exist for dietitians; including roles in stroke management, gastroenterology and outpatient enteral feeding [ 10 – 12 ]. Although a variety of extended scope of practice roles for dietitians are identified in the literature, few studies have focused on evaluating these roles [ 10 , 12 – 22 ]. Nevertheless, the limited evidence suggests that extended scope roles for dietitians provide similar positive outcomes to those evidenced by the initiation of other allied health ESP roles.…”

Section: Introductionmentioning

confidence: 99%

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The activities of a dietitian-led gastroenterology clinic using extended scope of practice

Ryan

Pelly

Purcell

2016

BMC Health Serv Res

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BackgroundExtending the scope of practice of allied health professionals has been a strategy adopted in the United Kingdom to address issues within the health system.Australia’s health system is currently undermined by similar issues, heightening government interest in adopting the extended scope health care model. The aim of the current study was to describe the activities and outcomes of a dietitian-led gastroenterology clinic which operated under an extended scope of practice model in an outpatient gastroenterology department at a tertiary hospital in regional Queensland, Australia, and to assess patient satisfaction with the initiative.MethodsA descriptive, cross-sectional case series undertaken over 50 clinics involving 82 category 2 and 3 patients with suspected/confirmed coeliac disease or inflammatory bowel disease; low haemoglobin; gastroesophageal reflux disease, or; malnutrition. Data was analysed using Microsoft Excel 2010, and presented as descriptive statistics.ResultsSixty out of 82 selected patients (median age 51 years) attended an initial appointment with the dietitian. Twenty-four review appointments were attended. Average waiting period for an initial appointment was 148 days (range 31–308 days). A total of 149 management strategies were provided, and 94 (63 %) of these involved the dietitian utilising extended scope of practice. The dietitian managed 47 (78 %) patients without need for gastroenterologist referral, and 25 (42 %) were discharged after dietetic management.Patients reported high levels of satisfaction with the clinic.ConclusionsSeventy-eight percent of category 2 and 3 patients referred to the gastroenterologist could be managed exclusively in the dietitian-led clinic. This extended scope model of care could potentially benefit the efficiency and acceptability of Australia’s public health system.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The activities of a dietitian-led gastroenterology clinic using extended scope of practice

Ryan

Pelly

Purcell

2016

BMC Health Serv Res

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“…The use of the HEN service has increased significantly in the past few decades and this has led to the development of various policies and guidelines for the management of enteral nutrition [28]. This has also contributed to the promotion of multidisciplinary team working and the extension of roles of the different professionals that make up the HEN team [27,29]. …”

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confidence: 99%

Recent Advances in Enteral Nutrition

Ojo

Brooke

2016

Nutrients

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“…Several health‐care networks have since experienced attrition of credentialed dietitians because of staff turnover. Similar to the report of Stanley and Borthwick, the only significant instance of role boundary conflict was experienced by a dietitian aiming to develop an inter‐professional g‐tube clinic, and a specialist nurse. These were unable to be resolved in one of the health‐care networks and the new service was not implemented.…”

Section: Discussionmentioning

confidence: 58%

Introducing novel advanced practice roles into the health workforce: Dietitians leading in gastrostomy management

Simmance

Cortinovis

Green

et al. 2018

Nutrition & Dietetics

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Aim: The number of advanced practice roles in the Australian health-care system is growing alongside contemporary health-care reforms. The present study aimed to evaluate the impact of introducing novel advanced practice dietitian roles in gastrostomy tube (g-tube) management and develop a competency framework for progressing opportunities in dietetics practice and policy. Methods: A questionnaire was distributed to service lead dietitians at six participating health-care networks at the completion of a dedicated advanced practice funding grant, and at 12-month follow up. Service changes (e.g. number of dietitians credentialed, service and adverse events, change in patient waiting times and staff satisfaction), enablers and barriers for the implementation of the novel roles (including pre-, during, and post-implementation), and clinical costing estimates to measure the financial impact on the health system were investigated. Participant feedback was also used to synthesise the development of an advanced scope of practice pathway to competency. Results: Responses were received from all participating health-care networks. Five out of six sites successfully implemented an advanced practice role in g-tube management, with conservative health system savings estimated at $185 000. Ten dietitians were credentialed, with a further seven trainees in progress. Over 200 service events were recorded, including those diverted from other health professionals. Enabling factors for successful introduction included strong executive and stakeholder support, resources provided by grant funding, and established credentialing governance committees. Barriers included recruitment and governance processes. Conclusions: Opportunities exist for further expansion of advanced and extended practice roles for dietitians to meet future health-care demands.

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Extended roles and the dietitian: community adult enteral tube care

Cited by 13 publications

References 33 publications

The activities of a dietitian-led gastroenterology clinic using extended scope of practice

The activities of a dietitian-led gastroenterology clinic using extended scope of practice

Recent Advances in Enteral Nutrition

Introducing novel advanced practice roles into the health workforce: Dietitians leading in gastrostomy management

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