Dietetics Referral (Inpatient) 🥗
Guide for inpatient dietetics (dietitian) referral. Key information for malnutrition, refeeding, enteral and parenteral nutrition, and referral scripts for NCHDs.
📋 Key Info to Have Ready
- Patient identifiers: name, DOB, MRN, ward and bed location
- Reason for referral, being specific: malnutrition risk, poor oral intake, refeeding risk, enteral feed advice, TPN, therapeutic diet, or discharge nutrition plan
- Weight, height, BMI, and recent weight change (e.g. % loss over 3–6 months); say if weighed or estimated
- Current intake: eating and drinking normally, poor appetite, modified diet/fluids, oral nutritional supplements, NG/PEG fed, or nil by mouth (NBM)
- Swallow status and SALT input: safe for oral intake, thickened fluids, soft diet, or awaiting swallow assessment
- GI status: nausea, vomiting, diarrhoea, ileus, obstruction, fistula, short bowel, pancreatitis, IBD flare
- Relevant PMHx: cancer, chronic disease, alcohol misuse, eating disorder, diabetes, CKD, liver disease, recent major surgery
- Recent bloods: U&E, LFTs, bone profile, Mg²⁺, phosphate, albumin, glucose, FBC (flag low phosphate/K⁺/Mg²⁺)
- Medications and allergies that affect nutrition: steroids, insulin, diuretics, chemotherapy, food allergies or intolerances
- Urgency and plan: e.g. high refeeding risk, starting NG feed, considering TPN, or nutrition plan needed before discharge
🔎 Common Reasons to Refer
- Malnutrition risk or unintentional weight loss (screened or clinical concern per HSE food, nutrition and hydration policy)
- Prolonged poor oral intake, NBM, or inadequate intake despite encouragement and supplements
- High refeeding risk: prolonged starvation, low BMI, recent rapid weight loss, alcohol misuse, already low K⁺/Mg²⁺/phosphate (IrSPEN)
- Advice on oral nutritional supplements, fortified diet, or snack plans
- Enteral nutrition: NG/NJ/PEG feed choice, rate, and monitoring once the route is available
- Parenteral nutrition (TPN/SPN): dietetics and pharmacy lead regimens; refer early when the gut cannot be used adequately
- Therapeutic diets: renal, diabetic, gluten-free, texture-modified (with SALT), or allergy/intolerance diets
- Post-op or GI pathology with high nutrition needs: major resection, pancreatitis, high-output stoma or fistula, IBD
- Discharge planning: home supplements, home enteral feeding, or community dietetics follow-up
📞 Example Referral
- Hi, this is [Your Name], the intern from [Team Name]. I'd like to refer a [Age]-year-old patient on [Ward] to dietetics.
- They were admitted with [e.g. pneumonia / pancreatitis / bowel obstruction] and we're referring for [malnutrition risk / refeeding risk / NG feed advice / TPN consideration].
- Weight is [kg] (BMI [x]), with [e.g. 10% weight loss over 3 months / unknown baseline]. Current intake is [NBM / poor oral intake / on NG feed at x ml/h].
- Swallow is [safe / awaiting SALT / on modified diet]. GI status: [e.g. ileus resolving / high-output stoma / vomiting].
- Recent labs: phosphate [ ], K⁺ [ ], Mg²⁺ [ ], albumin [ ]. Refeeding risk appears [low / high]. We need advice on [supplements / feed plan / TPN / discharge nutrition].
- Many hospitals use an electronic or paper referral form rather than a phone call. Include the same details there, and phone dietetics directly if urgent (e.g. high refeeding risk, starting or holding feed, TPN).
📝 Tips
- Screen early and refer early: delayed nutrition support worsens outcomes and can block discharge
- If high refeeding risk, give thiamine and multivitamins before and during early feeding, correct critical electrolytes, and start slowly per IrSPEN / local protocol; involve dietetics the same day
- SALT advises swallow safety; dietetics advises nutrition targets, supplements, and feed regimens. Refer both when NBM or on a modified diet
- Do not start or accelerate TPN or complex enteral regimens without dietetics and (for PN) pharmacy input
- Weigh the patient (or document why you cannot) and trend intake; “poor appetite” alone is a weak referral without weight, intake, and the clinical question
- Weekend and out-of-hours dietetics cover is often limited; escalate medically if electrolytes are crashing after feeding, or if a feed/TPN bag is about to run out
- For complex cases (TPN, home enteral feeding, high-output stomas), raise at MDT so medical, surgical, dietetics, SALT, and pharmacy share one plan
- Spell out the question: “is oral intake enough?”, “safe NG feed plan?”, or “is PN indicated?” beats a vague “dietitian review”
Educational reference only. Medical disclaimer