Patient Food Service Research Articles

Is meal order timing and flexibility key to improving patient satisfaction with hospital foodservice?

The aim of this study was to retrospectively evaluate and compare patient foodservice (FS) satisfaction using a validated tool and consistent methodology in an acute health service for four different FS models as the organisation transitioned through traditional model (TM), choice at point of service (CaPOS), bedside menu ordering systems (BMOS) and room service (RS) from 2013 to 2016. Patient satisfaction data were collected using the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire. For the purposes of this study, patients' rating of their overall experience with FS (very good, good, okay, poor or very poor) was compared for each site and model. Satisfaction was significantly higher in the CaPOS and RS models compared with TM. BMOS, although somewhat higher, was not shown to be significantly higher than TM. The RS model was significantly higher than BMOS, but there was no significant difference observed between RS and CaPOS. FS models that support patient flexibility and meal ordering closer to the meal delivery time (as seen with RS and CaPOS) show higher patient satisfaction among hospital patients. It is recommended that sites consistently opt to include patient satisfaction as part of routine auditing. This would enable clear conclusions to be drawn regarding best practice FS models, based on specific and individual hospital requirements.

Intake Assessment Completed by Patient Food Service Assistants

Intake Assessment Completed by Patient Food Service Assistants

Home Food Environment Associations with Children's Dietary Intake and Weight Status

Traditional postoperative management of a patient undergoing colorectal surgery (CORS) begins with clinical monitoring of return of bowel function, followed by a clear liquid diet that is advanced to gastrointestinal (GI) soft diet. The purpose of this project is to survey patients on their food preferences within 72 hours after surgery and their levels of hunger, nausea, and pain. Between March and November 2012, 78 patients were surveyed using a 4-point Likert scale on their food preferences for 50 menu items. Their level of hunger, nausea, and pain were obtained using a visual analog scale ranging between one and ten. The survey revealed that CORS patients prefer a variety of liquid and solid foods. Within 24 hours after surgery, patients preferred a combination of liquids and simple solid foods such as coffee/tea, soups, saltine crackers, eggs, white rice/pasta. Most patients did not have a high preference for foods typical of a regular diet. Of those patients with a combination of low levels of hunger (61%), high levels of nausea (15%), and high levels of pain (45%), the most desired foods were: coffee/tea, fruit juice, potatoes, regular soup, pudding, white rice/pasta, saltine crackers, eggs, and ice cream. Twelve of 78 patients (15%) felt overwhelmed with the amount of food served on their first solid food tray. Survey results were presented to patient foodservice and modifications to current menu were implemented. A followup survey is planned to determine the effect of changes on meal satisfaction and tolerance.

Analysis of Intakes and Satisfaction of Patient Foodservice in Mid-Sized Hospital Settings

The purpose of this study was to investigate dietary intake and to evaluate patient satisfaction toward the quality of hospital foodservice. Questionnaires were distributed to 203 hospitalized patients in 3 hospitals having 300 beds. The intake rates for served amounts of rice, side dishes, and soup were 72.5%, 68.2%, and 62.6%, respectively. The main reasons for left-overs were ‘no appetite’ (25.8%) and ‘not salty enough’ (19.9%). The rate of patients eating outside food was about 33.5%. The average score for quality satisfaction of meal characteristics was 3.34 ± 0.61, and the average score for quality satisfaction of sanitation and service characteristics was 3.58 ± 0.61. ‘Seasoning’ showed the lowest score and ‘temperature’ showed the highest score for quality satisfaction of meal characteristics. In the quality satisfaction of sanitation and services, ‘explanation of meals’ showed the lowest score and ‘exactness of meal times’ showed the highest score. The patients hospitalized for 10 days showed significantly lower average scores than those hospitalized over 60 days for quality satisfaction of meal characteristics. The patients with ‘little appetite’ and ‘regular appetite’ showed significantly lower average scores than those with ‘much appetite’ for the quality satisfaction of meal, sanitation, and service characteristics. The patients who ‘rarely had leftovers’ showed significantly higher average scores than those who ‘always had leftovers’ and ‘often had leftovers’ for quality satisfaction of meal characteristics. Meal characteristic scores were significantly correlated with age (r = 0.216), length of admission (r = 0.310), appetite (r = 0.251), leftovers (r = 0.233), and intake of soup (r = 0.205). Also, sanitation and service characteristics scores were significantly correlated with age (r = 0.327), education (r = -0.202), length of admission (r = 0.168), and appetite (r = 0.155). Thus, it would seem to be desirable that hospital foodservices improve the taste and seasoning of meals and provide appropriate nutrition education and counseling in mid-sized hospitals. (Korean J Nutr 2011; 44(4): 326 ~ 337)

Implementing Composting and Recycling in Patient Food Service Systems

Implementing Composting and Recycling in Patient Food Service Systems

Transformation to Room Service Food Delivery In a Pediatric Health Care Facility

Patient food service is an important component in the nutritional management of hospitalized children. The previous meal delivery system at The Hospital for Sick Children in Toronto was a cold-plating re-thermalized system. Issues related to this model included order lead time, the reheating process, menu selection, and service style. Research into other systems led us toward room service, an innovative and flexible mode of meal delivery. Transformation to room service occurred over one year, and included implementation of a new computer system, kitchen renovation, redesign of menus and a new meal delivery system called Meal Train, and changes to human resource allocations. Throughout the transformation, consultations were held with key stakeholders, including the children's council, the family advisory, the nursing council, and a multidisciplinary committee involving nursing staff, dietitians, patient service aides, infection control personnel, occupational health employees, patient representatives, and food services staff. Now, Meal Train is running smoothly, and meal days and food costs have been reduced. Others considering a project like this must know their clients' needs and be willing to think outside the box. They should familiarize themselves with current information on systems and equipment, consult with key stakeholders within their organization, and then create the system that will work for them.

THE ACUTE HOSPITAL FOODSERVICE PATIENT SATISFACTION QUESTIONNAIRE: THE DEVELOPMENT OF A VALID AND RELIABLE TOOL TO MEASURE PATIENT SATISFACTION WITH ACUTE CARE HOSPITAL FOODSERVICES

The objective of this study was to design a valid and reliable questionnaire to measure patient satisfaction with acute care hospital foodservices. The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire was administered to a convenience sample of 2347 acute care hospital inpatients and postdischarge patients from two public hospitals (total 1050 beds) and one 360-bed private hospital in Queensland, Australia. A factor analysis and evaluation of Cronbach's alpha revealed that the final questionnaire contained 16 statements relating to four factors describing food quality (α = 0.89), meal service quality (α = 0.72), staff/service issues (α = 0.65) and the physical environment (α = 0.61). Questions requesting demographic data were included. Results indicated that the survey is an accurate, reliable measure of patient foodservice satisfaction. It differentiates the foodservice into four factors and collects detailed information about foodservice attributes within these factors. This allows the application of systematic measures to improve foodservice quality and provides a tool for the continuous assessment of foodservice quality and measurement of changes in patient foodservice satisfaction over time in a variety of acute care settings

Adopt-a-Floor program: A hospital work strategy that works

It's no secret that the nursing staff has a significant impact on how a patient perceives his or her overall hospital experience. Today's nurses have a significant volume of daily responsibilities, both clinical and nonclinical. Sometimes those responsibilities include issues related to patient food service. For something that has little to do with clinical responsibilities, food service can be a high factor in health care environments for both nurse managers and their staff.

The Spoken Menu Concept of Patient Foodservice Delivery Systems Increases Overall Patient Satisfaction, Therapeutic and Tray Accuracy, and is Cost Neutral for Food and Labor

The Spoken Menu Concept of Patient Foodservice Delivery Systems Increases Overall Patient Satisfaction, Therapeutic and Tray Accuracy, and is Cost Neutral for Food and Labor

Identification of Best Practices in the Delivery of Patient Food Services through Public/Private Sector Partnerships

This article describes the evolution of public/private sector partnership in patient food service delivery and identifies skills required by executives to manage partnerships effectively, features that may be generalized to other areas; arid the importance of labour relations. Site visits conducted across Canada demonstrate that when partners understand each other's objectives, commit to providing strong leadership, and create meaningful labour relations and communications strategies, partnerships can be successful.

Implementation of a Service Recovery Program Due to Food Service Downsizing

A Food and Nutrition Dcpartn dollar payroll reduction program (33%) in FY 96-97. The last phase of mis took place with the implementation of a patient tray cart rethermalization system and the elimination of 55 positions. The impact on customers was negative. Gaps in service level included some patients not receiving trays, hot food being served cold, poor food quality, long waits for trays, and inconsistent delivery of tube feedings/oral supplements/nourishments. Six months after implementation, a Patient Food Service Gold Standard Action Team (GSAT) was established to recover service levels. The effort was ted by a core team of four departmental members having strong, diverse management experience. All employees of Patient Food Services were members of the team. Objectives were to a) improve food quality, b) reassess functions and staffing patterns, c) develop an employee training program, d) establish a quality meat program, e) team build within, and f) enhance communication with Nursing. GSAT major accomplishments over a six-month period included a) altering the patient menu, b) changing from disposable to china entree plates, c) realigning staffing, d) documenting need for increase in staffing, e) developing an employee training program, f) establishing a quality management program, g) conducting regular meetings with first-line staff; h) sharing GSAT activities with Nurse Managers. Measures of success included meal rounds data, trayline audits, and patient satisfaction survey results. Patients stating “hot food not hot” has decreased from 8% to 1%. Response of “everything's okay” has increased from 50% to 97%. Tray accuracy, cart switch accuracy, and plating standards are consistently audited. This effort identified equipment problems, training deficiencies and performance issues. Currently, all performance parameters are consistently above 95%. Taste-testing helped to identify need for future product and recipe changes. Administration is reviewing the GSAT proposal for 6.8 FTE. Service recovery requires major investment of time and skills.

Strategies for Implementation of Consistent Carbohydrate Meal Patterns

Carbohydrate counting has been recommended as an appropriate method of meal planning for diabetic patients in hospitals as a means of meeting patients' nutrition needs and facilitating improved metabolic control for patients in acute care settings.Although meal plans utilizing consistent carbohydrate content were used in patient education, the clinical nutrition staff identified the continued use of “ADA-type” patterns in the patient food service as an obstacle to utilizing the patient menu and meal tray in reinforcing educational principles. Concerns were also identified with implementing a menu system that only utilized carbohydrate counting, i.e., meeting medical staff requirements, patient expectations, and increasing work for the diet office.Consistent carbohydrate meal patterns were developed with ranges of caloric content to accommodate most patients' nutrition needs. Diabetic menus were based on a cardiac-type diet pattern to provide an appropriate fat content for most patients. Guidelines for diet content were also established to facilitate meal correction: consistent selection of entrees by patients, maximum number of fruit servings allowed per meal, and goal for maximum number of fat servings/day. The use of sucrose-containing foods was limited at the time of implementation, although this may be modified in the future with continued education of the staff and greater public knowledge about consistent carbohydrate as a means of diabetic menu planning.

The Impact of a New Patient Foodservice Model Which Included a Spoken Menu on Efficiency and Effectiveness Measurements

Some hospital food and nutrition directors are reporting decreased costs and increased patient satisfaction ratings as a result of menu changes. However, a dearth of published empirical data exist regarding the impact of patient foodservice models, specifically spoken menu models, on efficiency and effectiveness. In this study, data were collected on two patient units during three phases: Phase I - current patient foodservice model; Phase II -spoken menu model; and Phase III - new patient foodservice model, which included a spoken menu and additional features. Efficiency was assessed through analysis of labor, late and wasted tray data; effectiveness was assessed using substitution, patient and nursing satisfaction data. Results included increased percentage of attendant time spent on patient interaction during Phases II and III; decreased percentage of late trays from Phase I to Phases II and III; increased percentage of wasted trays from Phase I to III due to Phase III model characteristics; a significant increase in nursing satisfaction from Phase I to III; and consistently high patient satisfaction during all phases. Both Phases II and III were more efficient and effective than Phase I. The distinction between Phases II and III is less clear without cost data regarding resources used.

A Patient Food Service Representative Means Personalized Service and a Lower Bottom Line

LEARNING OUTCOME: To describe the benefits of a patient representative in hospital food service.To effectively coordinate all aspects of patient meal service, a unique staff position was designed. The patient food service representative coordinates the flow of information concerning diet orders and food needs among clinical dietitians, nursing staff, patients/families, and food preparation areas. Job tasks include processing diet orders, delivering and retrieving trays, marking menus (including simple modified diets) with patients/families, preparing and delivering late items, and calculating food intakes for calorie counts. Carrying a beeper, the patient rep maintains an up-to-the-moment account of each patient's diet. Benefits realized in the past 6 years include feedback to the clinical dietitians concerning diet and feeding problems, and personalized customer service via a direct response to patient food preferences. Quality assurance monitors indicate proper food temperatures are maintained and missing tray items are less than 1%. Reduction of late trays to only 12%, and near elimination of lost trays has saved the department $76,000 annually. Nursing time in tray delivery was eliminated, and phone calls from nursing to food service have been reduced by 95% for additional savings of $47,000 annually. The patient rep provides the department with a visible, respected representative who is easily accessible to patients/families and clinical staff. In addition, having established such a system positions the department for a direct role in patient focused care.

Development and implementation of a human accuracy program in patient foodservice

For many years, industry has utilized the concept of human error rates to monitor and minimize human errors in the production process. A consistent quality-controlled product increases consumer satisfaction and repeat purchase of product. Administrative dietitians have applied the concepts of using human error rates (the number of errors divided by the number of opportunities for error) at four hospitals, with a total bed capacity of 788, within a tertiary-care medical center. Human error rate was used to monitor and evaluate trayline employee performance and to evaluate layout and tasks of trayline stations, in addition to evaluating employees in patient service areas. Long-term employees initially opposed the error rate system with some hostility and resentment, while newer employees accepted the system. All employees now believe that the constant feedback given by supervisors enhances their self-esteem and productivity. Employee error rates are monitored daily and are used to counsel employees when necessary; they are also utilized during annual performance evaluation. Average daily error rates for a facility staffed by new employees decreased from 7% to an acceptable 3%. In a facility staffed by long-term employees, the error rate increased, reflecting improper error documentation. Patient satisfaction surveys reveal satisfaction, for tray accuracy increased from 88% to 92% in the facility staffed by long-term employees and has remained above the 90% standard in the facility staffed by new employees.

Quality assurance audit: Sodium-restricted menus

A quality assurance audit was performed to evaluate the accuracy of prescribed sodium-restricted diets received by hospitalized patients. Sodium values were identified for all items on the audited sodium-restricted menu. Actual sodium values of the items to be served in a 24-hour period were tabulated from 48 menus after they had been corrected by the nutrition care clerk and compared with the prescribed sodium level. An acceptable variation of calculated sodium level vs. prescribed sodium level was determined to be plus or minus 10%. Of the sampled menus, 14.6% fell within this range, 22.9% were above, and 62.5% were below the standard set. Results of the audit led to training of clerks in calculation of sodium-restricted menus and inservice programs for all employees involved in patient foodservice regarding sodium-restricted diets. The results of a reaudit performed using the same methods showed a decrease to 12.2% of the menus above the standard and an increase to 26.8% in the number that met the standard, indicating increased accuracy of sodium-restricted diets.