Ms Belinda Steer1, Ms Kim Lunardi2, Ms Liz Broughan3, Ms Tobi Erickson4, Ms Tracey Martin5, Ms Leonie Pearce4, Ms Natalie Simmance2, Dr Judi Porter6
1Peter Maccallum Cancer Centre, Melbourne, Australia, 2St Vincent’s Hospital, Fitzroy, Australia, 3Northeast Health, Wangaratta, Australia , 4Austin Hospital, Heidelberg, Australia, 5Northern Health, Epping, Australia, 6Eastern Health, Box Hill, Australia
Background: Novel Advanced Scope of Practice (ASP) roles in gastrostomy tube (g-tube) management for dietitians were implemented in 5 Victorian health services in mid-2016. Following implementation there was evidence that these roles had resulted in diverting emergency department (ED) and endoscopy presentations, and therefore healthcare savings. This project looked at the results 2 years post-implementation.
Methods: A range of patient and service level outcome data were maintained by individual healthcare services and collated by a project lead.
Results: Across the 5 healthcare services, 8 dietitians have been credentialed in the ASP g-tube role with another 4 staff in training. Since commencement, >440 consults have been provided by the ASP dietitians. This includes >285 g-tube changes or removals, diverting >30 patients from ED, >140 patients from endoscopy and >335 patients from Gastroenterology review, at conservative cost savings of > AU$320,000 to the healthcare system.
This new model of care (including dietitian-led g-tube clinics and on call consultative services) has: 1) improved access to care from 2 months to 0-2 days; 2) reduced episodes of care for g-tube issues from 2-3 to 1; and 3) increased patient service satisfaction. Multi-disciplinary clinician satisfaction remains high, with medical staff actively promoting the ASP g-tube service to colleagues and patients, and the ASP dietitians reporting increased job satisfaction. The ability to provide comprehensive care for these complex patients, acknowledgement of their advanced nutrition support skills, and potential for career development were key reasons for this increase.
Conclusions: Embedding of this ASP role has bridged gaps and removed barriers previously placed on dietitians caring for patients with g-tubes. This has enabled the provision of comprehensive, patient-centred care and supported dietetic work at the full scope of practice. Further opportunities for ASP dietitian roles have been identified.
Belinda Steer is Head of the Nutrition and Speech Pathology Department at Peter MacCallum Cancer Centre in Melbourne. She has over 15 years experience as a clinical dietitian, including over 10 years specialising in oncology nutrition. and has a passion for providing high quality, patient-centred care.