Improving Efficiency Of Dietetic Services In Chronic Kidney Disease With A Categorised Referral Tool

Abstract

Over the past 3 years the number of CKD patients attending our renal outpatient service has increased dramatically from under 100 to over 400 patients. In this time dietetic resources within this service have remained unchanged. This has presented challenges for meeting current practice guidelines and has created long waiting lists to see the dietitian. The aim of this project was to determine the current status of dietetic appointments and reasons for referral. Using this information we proposed to develop a new referral tool and booking procedures to enable clear prioritization of patients and appropriate referral pathways. A nurses’ perceptions questionnaire and a 4-week audit of appointments were conducted. The new referral tool and booking procedures included categorisation of clinical dietetic priority, utilisation of other community dietetic services where appropriate, and explanatory notes of which patients should take priority in fully booked clinics. At baseline, it was found that 18 of 57 (31.6%) attempts to book dietetic appointments were not successful due to fully booked clinics (7 new and 11 reviews). While 6 of the 11 reviews were for reasons of higher dietetic urgency e.g. hyperkalaemia and malnutrition, 6 out of 7 new referrals were for lifestyle related reasons e.g. obesity, diabetes, and cholesterol. It is felt the new categorised referral tool and pathways will provide better guidance for referral and appropriate use of dietetic resources for CKD management, to be evaluated in early 2012.