Patient Transfer Best Practices

Nourish goes to great length to match patients with RDs. This complex alignment includes considerations of state licensure, schedule availability and the alignment between interests of the patient and qualifications of the RD.

The Nourish RD is educated and trained in food and nutrition science and dietetics practice. It is assumed that all Nourish RDs, as evidenced by the scope of their license and training, are equipped to manage the majority of patient conditions and MNT goals at Nourish. On occasion, a patient will have such a specific clinical need, that an RD with extensive experience might be the best fit for.

Ideally, the original match is a solid one, but the system is not foolproof and Nourish allows for patient transfers for the following two reasons:

1. RD can’t accommodate the patient on their schedule, have incorrect state licensure, or language/cultural considerations.

2. RD, after reviewing the patient’s intake form and/or conducting a session, realizes that the patients areas of interest do not align with their skills and expertise. Per the CDR’s scope or practice documentation, the scope of an RD includes delivering MNT, an evidenced-based application of the Nutrition Care Process (NCP) across a number of disease states, conditions, as well as general nutrition education.

Allowing patient transfers can ensure specialized care for all patients including those with complex medical histories. It is worthwhile to note that there are potential downsides to transferring patients to consider as well including disruption in continuity of care and suboptimal patient experience.

This guide is designed to help RDs navigate the patient transfer process.

The examples below are meant to exemplify common transfer scenarios and their optimal management. Sometimes there is one clear reason for the transfer, and other times its a combination of circumstances. Nourish understands that each scenario may not be identical to those provided.

Very clear specialty mismatch

• Example #1 State (include Red/Green State): IL (red state)

  • Pt Age/Preferred Pronouns: 35 yo, he/him

  • Reason for working with RD: “Dx with SIBO a month ago, I started a Low FODMAP diet, some symptoms have improved Dx with Celiac disease at age 10, have been gluten free since. Looking to manage GI symptoms and identify food triggers“

  • Specialties Needed: Gut Health, SIBO, Celiac, Autoimmune

  • # of Appointments with current RD: 0

  • Preferred hours/times hours: scheduled for Noon Friday, CST.

  • Reason for Transfer: RD does not specialize in gut health

• Example #2 State (include Red/Green State): TX (green state)

  • Pt Age/Preferred Pronouns: 28 yo, she/her

  • Reason for working with RD: “I’ve had a diagnosis of Anorexia for three years, and have always had a poor relationship with food/my body. I went to IOP treatment last year, but recently relapsed into behaviors. I feel anxious every time I eat. My therapist recommended work with an ED focused RD.”

  • Specialties Needed: Eating Disorder

  • # of Appointments with current RD: 0

  • Preferred hours/times hours: Afternoons 3-5pm PST

  • Reason for Transfer: RD does not specialize in eating disorders

When your availability does not match patient’s availability

• Example #1

  • State (include Red/Green State): OK (green state)

  • Pt Age/Gender: 53yo F

  • Reason for working with RD: gastric bypass-open RNY 2015. Recent weight regain and struggling with emotional eating at night time.

  • Specialties Needed: weight loss, emotional eating

  • # of Appointments with current RD: 1

  • Preferred hours/times hours: evenings

  • Reason for Transfer: Scheduling conflicts -Patient is only available 5-7pm EST moving forward, RD not available at these times

RD is not licensed in a red state

• Example #1

  • State (include Red/Green State): TX; pt moving to FL (red state)

  • Pt Age/Preferred Pronouns: 26 yo, she/her

  • Reason for working with RD: Pt dx with Binge eating disorder & pre-diabetes this year. “I’m struggling with poor relationship to food”

  • Specialties Needed: ED, emotional eating, BED, pre-diabetes

  • # of Appointments with current RD: 3

  • Preferred hours/times hours: morning/midday - EST

  • Cultural/Language Needs: Prefers Spanish speaking RD

  • Reason for Transfer: Pt is moving to Florida in 2 weeks, Current RD not licensed in Florida

Approach to care mismatch

All RDs at Nourish provide sustainable and evidence-based care that requires meeting patients where they are at. Dietitians should be able to collaborate effectively with patients holding diverse nutritional beliefs. If there is research to support the objective, then the RD should provide guidance.

Example #1

• State (include Red/Green State): IL (red state)

• Pt Age/Preferred Pronouns: 26 yo, she/her

• Reason for working with RD: “I want a weekly meal plan to help with making healthy recipes for more energy and better eating habits”

• Specialties Needed: General

• # of Appointments with current RD: 0

• Preferred hours/times hours: Mondays or Wednesdays 11am CST

• Reason for Transfer: RD does not provide meal plans

If the RD needs additional info to confirm mismatch

• Sometimes the patient’s main goal is unclear or lacks enough detail. The RD is encouraged to see the patient to collect that information, rather than making assumptions based on the intake form. Very often, RDs are able to assist the patient with their concerns after doing a full assessment. Example #1 State (include Red/Green State): NC (red state) Pt Age/Gender: 28 yo male Reason for working with RD: Pt has not filled out intake form for initial apt yet, so I don’t have additional info Specialties Needed: Weight concerns, emotional eating # of Appointments with current RD: 0 Reason for Transfer: RD does not specialize in weight loss.

• Example #2 State (include Red/Green State): VA (green state) Pt Age/Gender: 32 yo male Reason for working with RD: ‘I am experiencing extremely debilitating medical issues. I’ve been diagnosed with Generalized Hypermobility, Craniocervical instability, ME/CFS, Hashimoto’s, Polymialgia, mild kidney disease, among many other things. I need to get control of my health with eating habits that will lessen my symptoms and lead to a more fulfilling life. I currently can’t get out of bed and am required to be upright less than 1 hour per day and for only five minutes at a time. My current restrictions are impossible to live a functioning life. I need intense training on how to increase my quality of life and hope that dietary changes can be a good tool to add in to the other tools I’m attempting to coordinate. Needs support with: Accountability, nutrition knowledge, education, meal ideas, building meal plan, building grocery list, cooking instruction/guide # of Appointments with current RD: 0 Reason for Transfer: RD not clear on patient needs or nutrition priorities with medical hx.
  Disclaimer: Check in on management of medical history and their chief complaint in regards to nutrition.

RD can effectively support patient’s primary concerns while requiring only minimal assistance for secondary issues

• Example #1 State (include Red/Green State): NC (red state) Pt Age/Gender: 64 yo male Reason for working with RD: ‘Mostly control of my weight is the main goal long term’ Specialties Needed: Weight loss, Healthy aging, Heart health, Emotional eating # of Appointments with current RD: 0 Preferred hours/times hours: Unknown, Initial apt is at 6pm Reason for Transfer: RD does not specialize in emotional eating

• Example #2 State (include Red/Green State): WA (green state) Pt Age/Preferred Pronouns: 43 yo, she/her Reason for working with RD: “I had an eating disorder when I was in my 20’s. I still struggle with my relationship with food. I’ve made a lot of progress but need some help with meal preparation and meal planning.” Specialties Needed: Eating Disorder # of Appointments with current RD: 0 Preferred hours/times hours: Mornings 9am-11am MST Reason for Transfer: RD does not specialize with eating disorders Disclaimer: ED is not currently active and not what the patients came to Nourish for. As with all medical history, consider it when treating the whole patient. If the eating disorder becomes active, transfer can be considered.

Personality fit

• RD does not feel this patient is a good personality fit. Patients can initiate transfers for this reason while dietitians should refrain from doing so. Example #1 State (include Red/Green State): MO (red state) Pt Age/Gender: 28 yo male Reason for working with RD: I want to PR in my next marathon Specialties Needed: Performance Nutrition # of Appointments with current RD: 2 Reason for Transfer: RD does not feel this is a good personality fit

Patient demonstrates inappropriate behavioral conduct

• This is not a reason to transfer. Nourish RDs should not sustain abusive encounters. Please harassment or inappropriate conduct to a Clinical Quality Manager for guidance.

Nutrition intake forms are not always accurate and rarely provide ALL clinically relevant information.

⏩ Proceed to RD PTO Policy