“If you are the smartest person in the room, then you are in the wrong room” – a dietitian’s perspective
Gastrointestinal specialist dietitian, Graeme Syme tells us about how his role within Barts Health Trust has evolved in light of the COVID-19 pandemic.
When people ask what I do for a living and I tell them I'm a dietitian, the main responses are questions related to weight loss. While dietitians do work to help patients lose weight, this makes up a small part of dietetics and tends to be done in primary care i.e. community centres, with a lot of emphasis on education and behaviour change.
The majority of dieticians working in the acute setting will have a focus around disease related malnutrition. 30% of patients admitted to a hospital are malnourished and the number grows, as does the length of admission. Poor nutrition has a direct impact on a patient’s recovery rate and poses further risks to wound breakdown and infections. Whether an acute illness or chronic disease, good nutrition is essential in aiding recovery. Dietitians are experts in disease related nutrition and often specialise in their chosen field.
My area of interest is gastroenterology where I’m involved in a wider team of consultants and nurses providing a service for patients with Inflammatory Bowel Disease (IBD). The management of IBD is aimed at reducing inflammation when the disease is active and preventing future episodes. The service promotes excellent communication services with patients and the wider team, good communication = proactive escalation and management, preventing further complications and avoiding hospital admissions. Nutritional plans can be implemented as early as possible in our outpatient clinics. The goals include preventing malnutrition/early planning and optimising for surgery and treating by means of specialist liquid diets.
As the NHS quickly adapts to tackle the Covid pandemic, our services rapidly evolve. Dietitians from a variety of services are efficiently transitioning to support the Intensive Care Unit. Outpatient consultations are switched to telephone and emails services to prioritise ICU. Here patients can require ventilation and sedation, dependent on tube feeding as their primary source of nutrition. Infection and trauma can increase the patients nutritional requirements, pain relief and sedation can affect the body’s ability to absorb and utilise macro and micronutrients. Nutritional requirements are estimated based on respiratory status, gender, weight, body composition and blood profile. The ITU dietitian has a keen eye for detail, meticulously reviewing electrolytes, hydration, aspirates, bowels and blood sugars and amending the plan accordingly.
Like many of my colleagues, I have been helping out in ICU and other priority areas over the last 4 weeks. Our dietetic service has divided into two separate teams in support of a seven day service. Dietitians from renal, paediatrics and community have been upskilling with the support of our very patient and approachable ICU dietitians. The environment may look a little different from my normal role, however the faces are just as friendly!
“If you are the smartest person in the room, then you are in the wrong room.”- Confucius
I would like to give a shout out to my fantastic dietetic colleagues for the positive and ongoing support within the team and also to the medical students who have integrated within the department to help during this period.
A small proportion of our fantastic team!