Monitoring accountability of a clinical nutrition service

The first step in the effort to establish a stronger link between nutrition care intervention and health status is to identify actual services provided. This study examined the accountability of a clinical dietetic staff by using an explicit procedure that made it possible for performance to be measured. Data were gathered at an urban teaching hospital to determine the nutrition care provided as compared with stated standards. Using the Policy and Procedure Manual as the written standard, the authors analyzed data from medical record audit, time utilization studies, staff interviews, and monthly reports. The level of accountability was very high, with less than 1 discrepancy in 10, for all the data collected. The dietetic staff members at the hospital verified the attainment of established standards by clearly and specifically documenting their services. It would appear that a decision about priorities and responsibilities had been made that was well supported by staff and institution. The establishment of a nutrition care team, in which clinical dietitians assumed a supervisory role that promoted and supported delegation to dietetic technicians and dietetic assistants, also contributed to good performance.