All Aboard Meal Train: Can Child-Friendly Menu Labeling Promote Healthier Choices in Hospitals?

OBJECTIVE: To evaluate patient meal orders and consumption with a revised menu design that includes child-friendly labeling. STUDY DESIGN: A randomized controlled trial among hospitalized children was performed over a 1-month period comparing the control menu layout and the intervention menu. The intervention menu contained the same choices but was labeled to encourage healthy eating. Children on a specialized diet, receiving parenteral nutrition, or age <2 years were excluded. RESULTS: A total of 163 patients (81 males) were included, with a mean age of 9.9 ± 5.1 year, and a mean weight z-score of -0.08 ± 1.3. Children receiving the intervention ordered more "green-light" healthy choices and fewer "red-light" items, with 0.65 lower odds of selecting a red-light item (95% CI, 0.55-0.76) and 1.75 higher odds of selecting a green-light item (95% CI, 1.49-2.04), both at the first meal, but with effects waning over time. There were trends toward increased intake of fruits and vegetables and decreased intake of "foods to limit", but no impact on the consumption of sugar-sweetened beverages. Both intervention and control group consumed their meals in equal proportions. CONCLUSIONS: The combination of menu labeling techniques targeted to children in the inpatient hospital setting was an effective short-term tool for increasing the intake of healthier foods, although the effect of labeling waned over time. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02692001.

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.