Development of dietetic staffing requirements for adult intestinal failure services using a best-practice model

The number of people diagnosed with chronic intestinal failure (CIF) worldwide is low. The condition is clinically complex to manage and resource intense. Guidance on best-practice staffing levels is lacking. This paper proposes a methodology for determining dietetic staffing levels for adult CIF to estimate dietetic staffing levels allowing patients access to best-practice care.

After undertaking a literature search, a novel method for developing recommended adequate dietetic staffing within adult CIF services was utilized. This included (1) mapping the current patient journey and best-practice dietetic care throughout the journey, (2) allocating clinical and nonclinical hours at each phase of the patient journey, and (3) calculating percentage clinical time, and (4) finalizing estimated dietetic staffing requirements per patient.

Current literature informed mapping the patient journey and dietetic best practice for CIF. Australian data were included where possible to reflect patient care locally. Direct and indirect clinical hours were allocated to each activity. Allowing for nonclinical activity of 40% for a senior clinician, total hours required to provide best-practice care per patient was calculated as 0.028 of a full-time dietitian per adult with CIF. This equates to the management of 36 people with CIF per full-time dietitian.

Use of a bottom-up methodology allows calculation of staffing to meet best practice. Proposed dietetic staffing levels obtained from this study are far greater than current allocated staffing within the Australian adult CIF setting. Adequate dietetic resourcing may reduce patient complications and improve quality of life, resulting in enhanced patient and clinical outcomes.