Name Rebecca Hoffman

Date of report submission June 21st 2015

Activity Shadow Dietitian

Date of the Service June 19th 2015

Learning Objectives: Learn what a clinical dietitian does and some changes in the field.
Contact Information
Name Debbie Radcliff MA, RD, LD
Promedica Defiance Regional Hospital
1200 Ralston Avenue
Defiance OH
419-783-4492
Debbie.radcliff@promedica.org

Reflection and Objectives.

Promedica Defiance Regional Hospital is a member of the Promedica chain.
Debbie Radcliff is the only dietitian on staff in this hospital serving all of the patients in
and out of the hospital. Some service that the hospital has are the coping center, a
womans center, and ER and trauma unit, hearing services, heart services, and a center
called Kaitlins Cottage. I love this hospital because it is fairly new and has a large list of
services. My mother has been the pharmacist here for almost 20 years so it feels like a
second home to me.
When I went to see Debbie I had 10 objectives as follows.
1) What is your typical day like
a. Debbie said her day is diverse but in the morning she will gather up
the charts for the patients she will see and look at her calendar to see
what kinds of put patients she has coming in for the day for
counseling. Debbie said she wears many hats in the hospital because
she is the only dietitian for a fairly large hospital. She said she also
works with the discharge team to make sure patients that are leaving
have good nutrition information because they are usually not in the
hospital long and at defiance the average length of stay is 2.3 days.
2) What are some common diseases that you see?
a. Debbie said that she most often sees diabetes and because of the cardio
unit she sees a lot of CHF and CAD. She said that because of the
coping center she also sees a lot of nutrient deficiencies as a result of
drug abuse. She will have some gallbladder and pancreatitis but most
serious things and more server surgeries will get shipped to larger
hospitals in the Promedica network like Toledo.
3) How do you conduct a typical outpatient counseling session?
a. Debbie said she usually tries to run the session for 1 hour and 15
minutes to as long as 2 hours. She starts by making the person feel
comfortable and sharing experiences to connect with the patient. She
then starts to build a foundation of nutrition education and uses food
labels and food models to help. She will always use open-ended
questions and have the patient teach it back to her when they are done
to see if the patient understood it.
4) How do you run an inpatient session?
a. Debbie said one big difference is that an in patient session is very
shout compared to outpatient. She said that there are usually
distractions from other members of the health care team and that she
doesnt have time to see everyone that may need attention.
5) What are some complications that you run into with patients?
a. She said some people have a know it all attitude and just dont want to
take her advice and in those cases you want to remind the person that
you are tiring to help them and you have their best interest in mind.
Sometimes you will also have language, kids, family members,
learning disabilities and even a person being blind of deaf that are all

there as barriers. Debbie said that you always want to bring it back to
the patient and simplify as much as you can.
6) What tools do you use on a daily basis?
a. Debbie uses growth charts, charts for estimating needs, diabetes
education manuals, the Nutrition care process pocket guide, food
labels, and models and she also uses a sheet that has the questions you
would ask so that she doesnt forget any questions.
7) What changes do you see coming in technology for dietetics?
a. Debbie said the biggest change is going to be EMR, which will bring
standardization between not only hospitals within a network but also
hospitals from other networks. Debbie said that out of the 11 hospitals
in the Promedica network defiance is one of the last 2 until March and
that is a problem because they are behind.
8) What are some changes that you see from the Affordable Care Act?
a. Debbie said that she isnt sure what is going to be happening with the
ACA but she said that she has been documenting a lot more in depth
when a patient refuses her services because she isnt sure what kinds
of reimbursement problems there will be.
9) What other changes do you see coming in the near future?
a. Debbie said that she sees hospitals cutting back on nutrition services.
She used to have a DTR helping her in the hospital but they let her o a
few years ago and now Debbie works alone. Debbie has seen other
hospitals in the area do the same thing.
10) What advice do you have for future RDs?
a. Debbie said that her biggest piece of advice is to be flexible and make
the information simple and to always try to enjoy what you do.
After asking these questions Kate, a fill in dietitian for the Promedica chain
showed up to help Debbie for the day as Debbie had been on vacation recently and is
trying to catch up. Kate and Debbie went through the patient charts and the outpatient
information as a team and they dispersed through the hospital to try to see as many
patients as possible. Overall I saw how hectic a day can be if you are a dietitian working
in a rural hospital.