Emergent Care Coordination SOP

Medical Nutrition Therapy (MNT) is an important healthcare intervention that can reduce disease risk and promote good health. Often, MNT in isolation can help patients resolve symptoms, promote good health, reduce disease risk, and feel empowered to make healthy lifestyle choices. That said, there are times when providing MNT or general nutrition education in isolation (i.e. in absence of an expanded or interdisciplinary HC team) might put the patient, and Nourish, at risk. A few examples of this might be:

• Patient has high risk lab value and is not seeing a provider for whom those results fall into their expertise

• Patient exhibits mental health instability or other signs of possible mental illness

• Patient comes to Nourish with a diagnosis that requires care outside of what MNT alone can provide

While patients have a right to be informed of their healthcare treatment and a right to refuse healthcare treatment, they cannot demand treatment, and at times isolated care from an RD is not in the patient's best interest.

1. If you believe your patient requires supplemental care from an external provider, but you do not believe the patient will be harmed or poorly impacted by MNT in isolation, you may make a referral(s) to the patient. The RD should not benefit in any way from the referral, and if possible a selection of more than one referral should be provided.

2. If you believe your patient requires supplemental care from an external provider, and you do believe that the patient will be harmed or poorly impacted by MNT in isolation, or the expertise the patient seeks is outside the scope of practice of RD-provided MNT, follow these steps:

   • Meet with the patient first. Do not make a care coordination determination based on what is included in the signup flow or intake form.

   • Document the concerns in the Assessment section of the chart note.

   • Explain your concerns to the patient, sharing that you do not believe that continued MNT care in isolation is in the best interest of their health. Reference authoritative guidelines wherever possible.

   • If the patient does not agree to the referral, seek guidance from your CQM to determine if the situation is critical enough to warrant dismissing the patient from Nourish practice.

   • If the patient does agree to the referral, follow the protocols for an effective and timely referral and ask the patient to add that provider to the ROI.

   • Give the patient a reasonable amount of time, with the expression of a documented deadline, to find an external provider and make an appointment.

   • Explain that if Nourish does not receive documentation of their visit with the external provider by [deadline] you will need to suspend care until they do.

   • Ask the patient if they would consider adding that provider to the Nourish ROI to allow for compliant communication in the future.

   • Document all communication - RD should document a summary of the conversation and what referrals were made. Notes should include plans for follow-up, including if the patient has agreed to the referral or note, and loops closure (i.e. Patient agrees to make an appt with primary care and will update RD at next session. RD explained that if patient has not seen PCP by next session, the session will be postponed. Should the notification come between session, RD should write update in the Addendum of the most recent note.