Symposium

4.The Roles Registered Dietitians are Expected to Play in Medical Care Support Team

Medical journalist
Maki FUKUHARA

1. To take pride in the fact that their occupation is the cornerstone of disease management.

Although this varies depending on the medical institution, over ten different types of medical care support team are currently being implemented in representative cases alone, with almost all the teams having registered dietitians as members. By having these nutritionists intervene with inpatients and help the patients maintain and enhance their immune systems, it became possible to (1) reduce deaths caused by surgery, (2) prevent infections and complications, (3) reduce the risk of developing bedsores, (4) bring about motivation for rehabilitation, and (5) realize early ambulation and recovery. The registered dietitians’ degree of contribution in these areas was clearly reflected in hospital management as well as in patient satisfaction levels.

For example, at Chikamori Hospital in Kochi Prefecture, registered dietitians mostly deal with patients who have common diseases such as stroke, ischemic heart disease, as well as digestive and urological diseases. Of the 338 hospital beds, 200 to 300 patients per month, or, in other words, over 2,000 patients per year, receive thorough interventions by the Nutrition Support Team (NST). As a result, despite the fact that approximately 30% of the inpatients are of advancing age over 65, the morbidity rates from infections and complications, as well as postoperative mortality rates fell as compared with 7 years ago before the NST began their activities. Fewer antibacterial agents, injection fluids and intravenous fluids were used, and generic drugs were aggressively employed to replace higher-priced drugs. Because of these measures, healthcare costs dropped by one-third, from 150 million yen in 2003 to 50 million yen in 2007. In addition, the number of meals served to patients capable of eating using their mouths increased by over 30,000 meals per year, and meals and medical treatment costs during hospitalization, which are paid on a fee-for-service basis, increased by 32 million yen in 2007 as compared with 2003.

If the quality of medical treatment is enhanced, patient satisfaction rises, and the medical institution enjoys a higher reputation in the local community. If the number of patients increases, and the hospital bed utilization rate increases (Chikamori Hospital: 99.48%), this greatly contributes to hospital income and expenditure. In other words, the results of the NST medical care support team program have shown that registered dietitians are “key individuals” who help generate a positive cycle. They are strongly encouraged to engage in their work with pride, and create a favorable cycle at hospitals throughout Japan.

2.“Obtain primary information through the five senses” : accumulate experience to make judgments on one’s own

In medical care support team, registered dietitians are encouraged to come out of the kitchen and make rounds of hospital beds. They obtain information not just from the doctors, nurses and medical charts, but like doctors and nurses, they, too, have the opportunity to look directly at the patients with their own eyes, listen to what they say, and touch their bodies. This also applies to media people like us: coming in contact with the field is the most basic of all basic operations. By actually walking around clinical sites and repeatedly exchanging casual and friendly conversations with people close by, you can gather information in the form of “dots.” The dots gather to form lines, and become a volume that is large enough to make careful considerations and analyses. The result is a “plane” called an article. It is only then that we create a product which the readers want to learn about or read, and finally receive monetary compensation. Describing the act of utilizing the five senses and obtaining information, Dr. Takashi Higashiguchi, Professor of Surgery and Palliative Medicine at Fujita Health University School of Medicine, says, “Become a nutrition manager similar to a mother caring for her child.”

In medical care support team, moreover, under a physician’s comprehensive instruction, a registered dietitians will increasingly be called on to make judgments in light of his or her expertise, provide advice to doctors and nurses, and take action. In so doing, to gain the trust of team members, it is imperative that registered dietitians can make proper judgments by having accurate knowledge and information.

3. Never forget that meals can give a person the joy of living, too.

With the current hospital meals, emphasis is being placed on how the patients can eat them, and how to increase food that the patients want to eat. Chubu Rosai Hospital in Aichi Prefecture prepares a total of 71 different kinds of meals three times a day, comprising of 28 different general dishes, 39 kinds of therapeutic diet, and other kinds of fluid diet. They prepare approximately 1,500 meals per day, every single day. I truly respect their efforts.

To make this individualized meal program possible, Chubu Rosai Hospital has contract cooks and nutritionists who go visit the patients in their beds inside wards to hear what the patients feel and want. Since meals are one of the few pleasures during their stay in a hospital, the patients begin talking about wanting this and that. When a cook comes by their beds, some patients rejoice and say, “Oh, so you’re the one who prepares meals for us!” Although their visits are brief, lasting a little over 5 minutes, such communication reportedly brought the kitchen dramatically closer to patients’ beds, and greatly raised the awareness and motivation of the kitchen staff.

Yodogawa Christian Hospital in Osaka Prefecture serves “shigami-shoku” to patients who have difficulty eating and/or swallowing. Rice is served on a plate, topped with meats, fried shrimp and fresh vegetables. Patients put morsels inside their mouth, chew them well, and, after savoring the delicious taste, they spit them out inside a bag without swallowing them. The staff explained, “This eliminates the stress of not being able to eat, and provides a sense of satisfaction through chewing and savoring the food. Patients can also enjoy the experience of having meals delivered to them and they can stimulate the brain by chewing. In other words, this sort of meals boosts a patient’s immune system and the spirit to live.” When I heard this, I, being a housewife myself, was amazed at the tremendous power that the feeling of “It’s delicious!” can bring to people.