As Clinical Outreach Dietitian for New Hanover Regional Medical Center in North Carolina, Skip Allen spends his days calling on discharged patients in their homes, seeing how he can help them manage their medical and social needs. A trained dietitian, he works to solve nutrition-related challenges that can jeopardize their recovery and impede their path to wellness.
“The goal is to help malnourished patients bridge the gap between the nutrition they receive in the hospital and what they experience once they return home,” Allen says. “Malnutrition can lead to dangerous health complications, prolonged hospital stays and readmissions. We want to make sure patients who leave our facility have what’s necessary to thrive.”
Launched with a grant from The Duke Endowment, New Hanover Regional Medical Center’s community dietitian initiative began in 2019. It’s modeled on the medical center’s successful community paramedicine program — and hospital leaders believe there’s nothing quite like it in the country.
‘Connected to Everything’
Malnutrition — the inadequate intake of nutrients over time — includes undernutrition (underweight) and overnutrition (overweight and obesity). Some researchers say it affects about half of the patients admitted to an acute hospital setting. Most at risk are people from lower socioeconomic backgrounds, seniors and patients with chronic illnesses.
Malnutrition isn’t a new problem, but it has often been poorly diagnosed, says Angela Lago, New Hanover’s Manager of Clinical Nutrition.
“Dietitians are leading the way in identifying it, treating it and showing how it negatively affects a patient’s ability to heal and recover,” she says. “Nutrition is connected to everything. We can’t expect our patients to bounce back from a stroke, fall, surgery or any other medical condition if their nutrition is inadequate.”
At New Hanover Regional Medical Center, an 800-bed facility in Wilmington, registered dietitians screen patients for malnutrition and begin a nutrition intervention based on the diagnosis. Discharge instructions include how to properly nourish to maintain or rebuild strength and lean muscle mass.
But before the community dietitian initiative began, patients often had setbacks after returning home — especially since malnourishment can often overlap with “food insecurity,” which the USDA defines as lacking consistent access to adequate food.
“We didn’t know if they had access to nutritious food, if family members were able to help them obtain or prepare meals, if they were able to retain and implement the nutrition education they received, or if they were following the nutrition care plan that was created specifically to help them heal,” Lago says. “We wanted to begin addressing the underlying causes of illness — one of which is a patient’s access and relationship with food.”