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Background and aims Dietitians in acute adult services need to prioritise dietetic referrals in order to manage their daily workload and ensure effective treatment of patients. Newly qualified dietitians do not usually receive specific training on prioritisation and could be helped with an evidence-based, effective, decision-training tool that is based on the practice of experienced dietitians. We developed an internationally available web-based decision-training tool designed to improve novice dietitians’ ability to make dietetic prioritisation decisions. The training tool comprised of a pre-training task, a post-training task and training materials. The aim of this study was to test the effectiveness of the training tool on novices’ ability for dietetic prioritisation. Methods Pre-registration dietitians and recent graduates (one-year) from across the UK were invited to participate in this randomised controlled trial (RCT). Each participant made prioritisation decisions on a set of dietetic referral scenarios: 53 scenarios at pre-training and 27 at post-training. After pre-training the intervention group was presented with the training materials, whereas the control group was told to carry on with the post-training task. Participants did not know which group they had been randomly allocated to. We calculated i) level of agreement between decisions made by each novice and experts’ consensus using Pearson correlation, intra-class correlation (ICC(2,1)); ii) intra-rater consistency using ICC(1,1) and iii) intra-group consistency using ICC (2,1). We compared group means at pre-training and post training; estimated effect size using the degree of change from pre- to post-training, and 2-factor mixed ANOVA to assess overall effect of the training across the groups and time-points. Results 151 participants (69 in control and 82 in intervention) completed the trial. The groups did not differ in demographic characteristics. Both Pearson and ICC(2,1) correlations increased with training intervention; a moderate effect of training was found for both metrics, d=0.69 (r=0.32) for the former and d=0.54 (r=0.26) for the latter. Intra-rater consistency improved with training but with a small effect size, d=0.32 (r=0.16). The intra-group consistency also improved with training: ICC= 0.48 pre training to 0.61 post training. Conclusions The training tool was found to be effective in improving the novice dietitian’s ability to prioritise referrals in the acute adult setting. The training tool is freely available at www.dietitianreferral.org for use by all student or early career dietitians internationally. Funding: This work was supported by Imperial Healthcare Charity, London.

Background & Objective Dietitians need to prioritise referrals in order to manage their work load. Novice dietitians may not receive training on prioritisation and could be helped with an evidence-based, effective decision training tool. To develop such a tool, it is necessary to understand how experts make prioritisation decisions. This study aimed to model expert decision making policy for prioritising dietetic referrals in adult acute care services. Methods & subjects Social judgement theory was used to model expert decision making policy. Informational cues and cue levels were identified. A set of case scenarios that replicated dietetic referrals in adult acute services were developed using fractional factorial design approach. Experienced dietitians were asked to make prioritisation decisions on case scenarios. A model was derived using multiple regression analysis to elicit the weighting given to cues and cue levels by the experts when making prioritisation decisions. Results Six cues and 21 cue levels were identified and 60 unique case scenarios were created. Fifty experienced dietitians made decisions on these case scenarios. The “reason for referral” and “biochemistry picture” were the two most influential cues, and “weight history” was the least significant. “Nutritional status”, “presenting complaint” and “previous food intake” had similar weightings. 95.7% of the variability in the experts’ average judgement (adjusted R2=0.93) was predicted by the six cues. Conclusions A model for referral prioritisation in acute adult services described experienced dietitians’ decision making policy. This can be used to develop training materials that may increase the effectiveness and quality of prioritisation judgements. Funding was received from Imperial Healthcare Charity in the form of a research project grant.