Introduction

As a super-regional centre with patients from all over the UK frequent face to face contact is not feasible, therefore telephone or email dietetic consultations are necessary. Current dietetic review practice is to personally see patients at their annual review and outpatient appointments to provide assessment of nutritional parameters, intake and matching this to need. Telephone consultations are more ad hoc but are amenable to be standardised so to provide a robust dietetic follow up. We therefore report on current practise and recommendations for future standards of care.

Aim

To review our current practise of dietetic input and provide recommendations for future standards of care.

Methods

Dietetic notes of all patients who have a small bowel containing graft throughout 2018 who are cared for at Birmingham Children’s Hospital, were retrospectively reviewed to identify all patient contact during the study year. We then looked at the intensity of nutritional support and dietetic needs. Of note, some patients will also have local dietetic intervention.

Results

32 patients were under review throughout 2018. Table 1 shows the dietetic input required and table 2 the median number of reviews each group received. As expected the patients requiring the most intense dietetic intervention have received the most input. It is vital however to consider individual patient need as some patients on less intense intervention required more frequent review demonstrated in the range of patient contacts. 6 patients also had local dietetic input.

Conclusion

Dietetic input into small bowel graft patients in imperative. Rationalisation of resources means that those at high risk or high supplemental needs should be prioritised and a standard of care developed.

We propose the following standard:-

• Develop care pathway for each group highlighting frequency of follow up and method to escalate concerns to consultant.
• Written information for families regarding review process to ensure early reporting of concerns.
• Referral to local Dietitian where appropriate.
• Telephone proforma to ensure consistency.