Why do patients refuse hospital meals? Reflections on the nutritionDay Audit at the University Hospital in Krakow.

I n t r o d u c t i o n: Despite increased awareness of malnutrition and improved nutrition-related policies, there are still cases of deterioration of nutritional status during hospitalisation. NutritionDay is an audit organised by the European Society for Clinical Nutrition and Metabolism (ESPEN), the Medical University of Vienna and the Friedrich-Alexander University Erlangen-Nürnberg (FAU) to prevent the onset of malnutrition and to improve hospital policies to deal with this problem. The aim of the study was to analyse the results of the audit with regard to factors that may contribute to the deterioration of a patients' nutritional status in hospital setting. Materials and Methods: This cross-sectional study was performed in a tertiary teaching hospital and was part of an international audit. The questionnaires used were provided by the nutritionDay office, and included information on weight loss, patients' appetite, dietary restrictions, food intake and reasons for food rejection during hospital stay. R e s u l t s: Of the examined patients, 61% reported weight loss prior to the current hospital stay. We identified 25 patients who did not consume a whole portion of their main meal on the day the audit took place. Approximately 17% of the patients' complaints could be resolved within a hospital ward. C o n c l u s i o n s: Hospital patients often eat less than a standard meal portion. Identifying the reasons for meal rejection may be helpful for development of standards for nutritional care in the hospitals.

Hospital Inpatient Nutrition Service Errors and Patient Safety Interventions: A Scoping Review.

OBJECTIVES: Food service errors are prevalent in healthcare hospital inpatient settings. Like medication administration errors, these mistakes can result in disastrous consequences. This scoping review aimed to identify the evidence describing hospitals' nutrition department service errors and subsequent patient safety interventions. METHODS: The review was conducted on four electronic databases, OVID MedlinePlus, PubMed, Scopus, and CINAHL, to search for articles reporting hospital food-related errors. All studies and reports on parenteral nutrition were excluded, and errors reported by departments other than nutrition services were excluded. A total of 245 studies published from 1984 to 2022 were identified. After removing duplicates, 98 abstracts were evaluated, with particular attention given to dietary errors, meal accuracy, and interventions. RESULTS: Twenty-nine articles were selected, and 14 (n = 14) were considered relevant to the review after a full-text review. More than half of the studies (n = 8) were conducted outside the United States. Eight studies (n = 8) were descriptive, retrospective, and observational; 3 were mixed-method studies (n = 3), 2 (n = 2) were quality improvement projects, and 1 was an implementation study (n = 1). Four (n = 4) studies were published before the year 2000. CONCLUSIONS: Various types of nutrition service inaccuracies were identified. The severity, causes, and stages of food service provision where errors occur were also documented. These errors were used as the basis for interventions to improve patient safety, justify implementing computerized dietary services systems, or add resources to augment dietary department service offerings. This review also generated valuable recommendations to promote patient safety by mitigating food service errors.

Diverting Food Waste From Landfill in Exemplar Hospital Foodservices: A Qualitative Study.

BACKGROUND: The US Environmental Protection Agency Food Recovery Hierarchy suggests methods for diverting food waste from landfill. Knowledge of how hospital foodservices implement food waste management strategies could help modernize food waste practices. OBJECTIVE: The aim of this study was to explore hospital staff members' experiences of implementing a food waste management strategy to divert food waste from landfill in their hospital foodservice, including the journey, challenges, and facilitators of this practice change. DESIGN: A qualitative study was conducted in 2022-2023 using semi-structured interviews. PARTICIPANTS/SETTING: Eighteen participants were staff members with knowledge of the food waste management strategy from 14 exemplar hospitals in United States, Spain, Scotland, and Australia using strategies to divert food waste from landfill within the last 10 years. ANALYSES PERFORMED: Mapping and thematic analysis were undertaken to code and identify themes from the interviews that described staff members' experiences of the journey to implement the strategy. RESULTS: Six hospitals donated food, 1 transferred food waste for animal feed, 4 used an industrial solution, and 3 sent food waste for composting. A common journey pathway for successful implementation was identified from participants' experiences. It features the following 6 phases: idea, preparation, roll out, maintenance, established practice, and evolution. Facilitators included legislation, enthusiastic staff members, executive support, and "luck." Challenges were smells, occasions when food waste was not collected, equipment breakage, and funding depletion. CONCLUSIONS: This study identified a common journey pathway for implementing a food waste management strategy in hospital foodservices that can be used to anticipate and prepare for the steps in the implementation process.

Guía de práctica clínica para el manejo de la desnutrición o el riesgo de desnutrición en el adulto / Clinical practice guideline for the management of malnutrition or the risk of malnutrition in adults

La desnutrición es un estado de nutrición caracterizada por una deficiencia de energía, proteínas y otros nutrientes que provoca efectos adversos en el cuerpo humano, impactando en la funcionabilidad y en el resultado clínico (1, 2). Las principales causas de la desnutrición están orientadas a una ingesta insuficiente, problemas en la digestión o absorción, alteración de las necesidades metabólicas de nutrientes y pérdida excesiva de nutrientes (3). Siendo la desnutrición asociada con la enfermedad causada en principio por la inflamación propia de la enfermedad, lo que causa alteraciones metabólicas. Asimismo, una reducción de la ingesta de alimentos o de la absorción de nutrientes, combinada con una inflamación aguda o crónica por alguna enfermedad adicional, puede provocar una alteración de la composición corporal y una disminución de la función, la cual se denomina desnutrición asociada a una enfermedad o a una lesión (1, 2). En el Reino Unido la prevalencia de desnutrición en los adultos es 25% (4) aumentando progresivamente en los adultos mayores. En Irlanda la media de riesgo de desnutrición en los pacientes que ingresan a los centros hospitalarios es de 30% (5). Además a nivel de Latinoamérica se ha observado una prevalencia de riesgo nutricional de 41%(6).. A nivel nacional se ha observado que en un hospital de alta complejidad como el "Hospital Nacional Guillermo Almenara Irigoyen" en el Servicio de Cirugía de Emergencia se realizó tamizaje para detectar riesgo de desnutrición, hallándose un 34.5% de pacientes con riesgo de desnutrición de moderada o severa al momento del ingreso. En cuanto a su evolución nutricional durante la hospitalización, el 16% empeoró en su estado nutricional (7). La optimización de la detección, manejo y monitoreo de los casos de desnutrición podría tener impacto en reducir su morbimortalidad y complicaciones(8). Por ello, el Seguro Social de Salud (EsSalud) priorizó la realización de la presente guía de práctica clínica (GPC) para establecer lineamientos basados en evidencia para gestionar de la mejor manera los procesos y procedimientos asistenciales de la presente condición. Esta GPC fue realizada por la Dirección de Guías de Práctica Clínica, Farmacovigilancia y Tecnovigilancia del Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) de EsSalud.

ESPEN guideline on hospital nutrition.

In hospitals through Europe and worldwide, the practices regarding hospital diets are very heterogeneous. Hospital diets are rarely prescribed by physicians, and sometimes the choices of diets are based on arbitrary reasons. Often prescriptions are made independently from the evaluation of nutritional status, and without taking into account the nutritional status. Therapeutic diets (low salt, gluten-free, texture and consistency modified, …) are associated with decreased energy delivery (i.e. underfeeding) and increased risk of malnutrition. The European Society for Clinical Nutrition and Metabolism (ESPEN) proposes here evidence-based recommendations regarding the organization of food catering, the prescriptions and indications of diets, as well as monitoring of food intake at hospital, rehabilitation center, and nursing home, all of these by taking into account the patient perspectives. We propose a systematic approach to adapt the hospital food to the nutritional status and potential food allergy or intolerances. Particular conditions such as patients with dysphagia, older patients, gastrointestinal diseases, abdominal surgery, diabetes, and obesity, are discussed to guide the practitioner toward the best evidence based therapy. The terminology of the different useful diets is defined. The general objectives are to increase the awareness of physicians, dietitians, nurses, kitchen managers, and stakeholders towards the pivotal role of hospital food in hospital care, to contribute to patient safety within nutritional care, to improve coverage of nutritional needs by hospital food, and reduce the risk of malnutrition and its related complications.

Guidelines on Standard and Therapeutic Diets for Adults in Hospitals by the French Association of Nutritionist Dieticians (AFDN) and the French Speaking Society of Clinical Nutrition and Metabolism (SFNCM).

AIM: Hospital food provision is subject to multiple constraints (meal production, organization, health safety, environmental respect) which influence the meal tray offered to the patient. Multiple diets can add complexity and contribute to non-consumption of the meal. To avoid undernutrition, it appeared necessary to propose guidelines for foods and diets in hospitals. METHODS: These guidelines were developed using the Delphi method, as recommended by the HAS (French Health Authority), based on a formal consensus of experts and led by a group of practitioners and dieticians from the AFDN (French Association of Nutritionist Dieticians) and SFNCM (French Society of Clinical Nutrition and Metabolism). RESULTS: Twenty-three recommendations were deemed appropriate and validated by a panel of 50 national experts, following three rounds of consultations, modifications and final strong agreement. These recommendations aim to define in adults: 1-harmonized vocabulary related to food and diets in hospitals; 2-quantitative and qualitative food propositions; 3-nutritional prescriptions; 4-diet patterns and patient adaptations; 5-streamlining of restrictions to reduce unnecessary diets and without scientific evidence; 6-emphasizing the place of an enriched and adapted diet for at-risk and malnourished patients. CONCLUSION: These guidelines will enable catering services and health-care teams to rationalize hospital food and therapeutic food prescriptions in order to focus on individual needs and tasty foods. All efforts should be made to create meals that follow these recommendations while promoting the taste quality of the dishes and their presentation such that the patient rediscovers the pleasure of eating in the hospital.

Hospital Food Experience Questionnaire (HFEQ): Reliable, valid and predicts food intake in adult patients.

BACKGROUND & AIMS: Low food intake is a primary contributor to iatrogenic hospital malnutrition and can be influenced by perceptions of poor food quality. Valid and reliable tools to assess the food experience of hospital patients are lacking. This study aimed to determine the internal reliability, convergent construct and predictive validity of the new Hospital Food Experience Questionnaire (HFEQ) and to methodically derive and test a shortened version of the questionnaire (HFEQ-sv). METHODS: Data from a multi-site study on 1087 patients from 16 Ontario hospitals were used. The HFEQ was developed to assess the importance of food (n = 6) and food-related (n = 10) traits using a 5-point Likert scale anchored by "not important" (1) and "very important" (5), and ratings of a single meal served (n = 7) using a 5-point Likert scale anchored by "very poor" (1) and "very good" (5). Food intake at the same meal was assessed using visual estimation (0%, 25%, 50%, 75%, 100%). Internal reliability was determined using Cronbach's alpha, and principal components analysis (PCA). Convergent validity was assessed using ordinal logistic regression with a single question on patients' overall meal quality rating. Cross validation was conducted in an attempt to shorten the questionnaire and binary logistic regression determined predictive validity with food intake. RESULTS: The HFEQ demonstrated good internal reliability (α = .86), and all but one of the questionnaire items clustered together in PCA, revealing 5 factors. Subscales and the total HFEQ demonstrated convergent validity, with the importance of food taste, choice, easy-to-open packaging, easy-to-eat food and local food provision, in addition to meal ratings of taste, appearance, texture, temperature and combination of food served being associated with the overall meal quality rating (p < .050). These items became the basis for the HFEQ-sv, which was found to independently predict food intake (LRT(42) = 142.17, p < .001). CONCLUSIONS: The HFEQ is internally reliable, demonstrates convergent validity with the construct of meal quality and predicts food intake. The 11-item HFEQ-sv promotes feasibility. The HFEQ has potential to be used globally to benchmark and quantify the patient food experience in hospital, contributing to quality improvement strategies that will support food intake among patients.

Improving mealtimes for patients and staff within an eating disorder unit: understanding of the problem and first intervention during the pandemic-an initial report.

BACKGROUND: Mealtimes occur six times a day on eating disorder (ED) inpatient units and are a mainstay of treatment for EDs. However, these are often distressing and anxiety provoking times for patients and staff. A product of patients' distress is an increase in ED behaviours specific to mealtimes. The aim of this quality improvement project was to decrease the number of ED behaviours at mealtimes in the dining room through the implementation of initiatives identified through diagnostic work. METHODS: The Model for Improvement was used as the systematic approach for this project. Baseline assessment included observations in the dining room, gathering of qualitative feedback from staff and patients and the development of an ED behaviours form used by patients and staff. The first change idea of a host role in the dining room was introduced, and the impact was assessed. RESULTS: The introduction of the host role has reduced the average number of ED behaviours per patient in the dining room by 35%. Postintervention feedback demonstrated that the introduction of the host role tackled the disorganisation and chaotic feeling in the dining room which in turn has reduced distress and anxiety for patients and staff. CONCLUSIONS: This paper shows the realities of a quality improvement (QI) project on an ED inpatient unit during the COVID-19 pandemic. The results are positive for changes made; however, a large challenge, as described has been staff engagement.

Older Adults' and Their Informal Caregivers' Experiences and Needs regarding Nutritional Care Provided in the Periods before, during and after Hospitalization: A Qualitative Study.

To enhance prevention and treatment of malnutrition in older adults before, during and after hospitalization, deeper understanding of older adults' and informal caregivers' perspective on nutritional care is important. One-time in-depth interviews were conducted with 15 older adults who had been discharged from hospital, and seven informal caregivers. We explored their experiences and needs regarding nutritional care provided in the periods before, during and after hospitalization. Five themes emerged from the data: (1) dietary intake, (2) food service during hospitalization, (3) nutrition-related activities, (4) whose job it is to give nutritional care, and (5) competing care priorities. Further, several opinions about nutritional issues were identified. Older adults and informal caregivers did not always experience optimal nutritional care. When discussing nutritional care, they mainly focused on the in-hospital period. When providing nutritional care and developing guidelines, older adults' and informal caregivers' perspective on nutritional care should be incorporated. Here, the periods before, during and after hospitalization should be taken into account equally.

[Clinical management in nutrition units]. / Gestión clínica en las unidades de nutrición.

INTRODUCTION: Introduction: total quality management (TQM) is an element of excellence in the practice of clinical nutrition that is less recognized than others such as continuous training or research. Objective: to discuss the foundations of quality management tools such as TQM or continuous quality improvement, to describe major achievements in this field in nutrition units, and to define the main challenges for the future. Results: in recent years, at least 9 clinical nutrition units have implemented TQM with quality certification by an external agency, in most cases AENOR and in accordance with the ISO 9001 standard. This has meant reflecting on the activities carried out by the units in order to meet user expectations, to document said activities, to ensure a better understanding of the organization, and to define the responsibilities of all staff, avoiding errors and redundant activities, with the result of improved time management and resources. Conclusions: TQM contributes to excellence in clinical nutrition because it represents a useful tool to improve organization and results in an efficient way. Although much progress has been made, there still remains a lot of work to be done in terms of developing processes, indicators, standards, and especially the coding of disease related malnutrition (DRM), due to its very important impact on patient care.

INTRODUCCIÓN: Introducción: la gestión clínica es un elemento de excelencia en la práctica de la nutricion clínica que está menos reconocido que otros, como la formación continuada o la investigación. Objetivos: el objetivo de este artículo es exponer las bases de las herramientas de gestión de calidad, como son los programas de gestión clínica (PGC) o de mejora continua de la calidad; describir los principales logros en este campo en las unidades de nutrición, y plantear los principales retos para el futuro. Resultados: en los últimos años, al menos 9 unidades de nutrición han implantado PGC con certificación de calidad por parte de una agencia externa, en la mayoría de los casos AENOR y conforme a la norma ISO 9001. Esto ha supuesto hacer una reflexión sobre las actividades que realiza la unidad con el objetivo de satisfacer las expectativas de los usuarios, documentar dichas actividades, asegurar un mejor entendimiento de la organización y definir las responsabilidades de todo el personal, evitando errores y actividades redundantes, con el resultado de una mejor gestión del tiempo y los recursos. Conclusiones: los PGC contribuyen a la excelencia en la nutrición clínica porque constituyen una herramienta útil para mejorar la organización y nuestros resultados de un modo eficiente. Aunque se ha avanzado mucho, aún queda mucho trabajo por hacer en cuanto al desarrollo de procesos, indicadores, estándares y, especialmente, la codificación de la desnutrición relacionada con la enfermedad (DRE), por su repercusión importantísima en la atención de los pacientes.

[Pillars for excellence in nutrition units - research]. / Pilares para la excelencia en las uidades de nutrición: la investigación.

INTRODUCTION: Research in clinical nutrition and dietetics consists of "carrying out intellectual and experimental activities in a systematic way with the purpose of increasing knowledge on this topic." The biomedical research carried out in clinical nutrition and dietetics units (UNCyDs) must be clinical-translational, which is understood as the fastest way to ensure that new scientific knowledge is transferred not only to clinical research but also to clinical practice. When UNCyDs conduct research, regardless of type and extent, they achieve higher quality standards in the health care they provide to their users. Clinical practice and scientific research are activities that constitute a continuous, indissoluble action. For this reason, both those responsible for health management and nutrition units and all their members have an obligation to promote research. In this article, a brief historical review of the birth of clinical nutrition as a scientific discipline is made, the legislation that supports biomedical research is briefly mentioned, the main keys to promote research in UNCyD are proposed, and finally orientation is offered on the main funding for biomedical research programs, and how to transfer and disseminate results.

INTRODUCCIÓN: Investigar en nutrición clínica y dietética consiste en "realizar actividades intelectuales y experimentales de modo sistemático con el propósito de aumentar los conocimientos de esta materia". La investigación biomédica que se realiza en las unidades de nutrición clínica y dietética (UNCyD) debe ser clínico-traslacional, entendida como la forma más rápida de conseguir que los nuevos conocimientos científicos se transfieran no solamente a la investigación clínica sino también a la práctica asistencial. Cuando las UNCyD realizan investigación, independientemente del tipo y la extensión, alcanzan mayores cotas de calidad en la atención sanitaria que prestan a sus usuarios. La práctica clínica y la investigación científica son actividades que constituyen una acción continuada e indisoluble. Por ello, tanto los responsables de las gerencias sanitarias como los de las unidades de nutrición y todos sus miembros tienen la obligación de fomentar la investigación. En el artículo se realiza un breve repaso histórico del nacimiento de la nutrición clínica como disciplina científica, se nombra someramente la legislación que sustenta la investigación biomédica, se proponen las principales claves para potenciar la investigación en las UNCyD y, por último, se orienta sobre las principales vías de financiación y sobre cómo realizar la transferencia y difusión de los resultados.

Patient-reported experiences of mealtime care and food access in acute and rehabilitation hospital settings: a cross-sectional survey.

BACKGROUND: Nutrition and mealtime interventions can improve nutritional intake amongst hospital inpatients; however, patient-reported experience is rarely considered in their development and evaluation. The present study aimed to measure patient-reported food and mealtime experience to evaluate and inform continuous quality improvement of hospital nutrition care. METHODS: A cross-sectional survey with inpatients in seven acute care and rehabilitation wards was conducted. A 27-item validated questionnaire measured five domains of patient experience: food choices, organisational barriers, feeling hungry, physical barriers to eating and food quality. Responses were summarised descriptively and compared between settings (acute versus rehabilitation), patient demographics (age, gender) and time in hospital. RESULTS: Responses from 143 participants (mean age 67 years, 57% male, 28% rehabilitation, median 6 days into hospitalisation) showed that 10% or fewer respondents reported difficulties with food choices, feeling hungry or food quality. The most common difficulties were opening packets (36%), insufficient menu information provided (29%), being interrupted by staff when eating (28%), being disturbed when eating (27%), being in an uncomfortable position when eating (24%) and difficulty reaching food (21%). There were no significant differences in domain patterns by sex, age group or time in hospital. Organisational barriers were reported less frequently amongst rehabilitation participants compared to acute care (P = 0.01). CONCLUSIONS: This survey highlights areas of positive patient-reported experience with nutrition care and suggests that local improvement efforts should focus on physical assistance needs and organisational barriers, especially in acute care wards. The questionnaire may be useful for informing and evaluating systematic nutrition care improvements.

Should plant-based hospital meals be the law? An American experience.

Hospitalization is an unparalleled opportunity for physicians to educate patients about the interconnection between poor dietary choices and the occurrence of many chronic diseases. For those patients who are ready to embrace nutrition as an essential part of the healing process, however, it is oftentimes difficult to find healthy menus at hospitals. Meat-based entrées, sugar-sweetened beverages and candy appear to be omnipresent in cafeterias and restaurants at U.S. hospitals. On the other hand, healthy plant-based menus are still the exception rather than the rule. Some states undertook considerable efforts to change this and made plant-based meals the law. Upon request by a patient, hospitals in New York are now required by law to provide plant-based options at every meal. This recent development triggered a controversial discussion within the medical community whether other states should follow this example and make plant-based hospital menus the law as well. This editorial illuminates why mandatory plant-based hospital menus could be a win-win situation for many involved stakeholders, including patients, hospitals and food services. This step is not a loss-marking venture for hospitals but rather a chance to save money and to improve corporate brand marketing at the same time. The introduction of mandatory plant-based menus in hospitals at a large scale represents a unique opportunity at the nexus of health, innovative corporate strategies and economics. Adequate framework conditions are necessary to ensure that all individuals can make healthy and affordable dietary choices while being hospitalized.

Hygienic-Sanitary conditions of Hospital Nutrition Services in Southern Brazil / Condições higienicossanitárias dos serviços de nutrição e dietética em hospitais do Sul do Brasil

This study evaluated the good handling practices in the ten Hospital Nutrition Services of the respective hospitals in the South of Brazil, classified as general hospitals. For data collection, there was used a Checklist for Good Handling Practices for Food Services based on current legislation. Among the results, the average of adequacy of the hospitals stand out, showing that the items related to responsibilities and edifications had the lowest adequacies, 67% and 73%, respectively, followed by the food handler block, with 76% of adequacies. The block referring to food handlers showed that few of them sanitize the hands during the change of activity. The classification of hospitals in relation to Good Handling Practices was satisfactory, however, greater failure was observed related to the practices of the food handlers, which are crucial for the safety of food produced in Hospital Nutrition Services.

Este estudo avaliou as boas práticas de manipulação em 10 serviços de nutrição e dietética de hospitais do Sul do Brasil, classificados como hospital geral. Para a coleta de dados, utilizou-se uma Lista de Verificação em Boas Práticas para Serviços de Alimentação baseada na legislação vigente. Dentre os resultados destacam-se a média de adequação dos hospitais, mostrando que os itens relacionados a responsabilidades e edificações apresentaram as menores adequações, 67% e 73%, respectivamente, seguidos com o bloco de manipuladores, com 76% de adequações. O bloco referente aos manipuladores de alimentos mostrou que poucos deles higienizam as mãos durante a troca de atividade. A classificação dos hospitais em relação à Boas Práticas de Manipulação foi satisfatória, no entanto, observou-se que falta o cumprimento de alguns itens, relacionados com as práticas dos manipuladores, que são cruciais para a segurança dos alimentos produzidos nos serviços de alimentação.

Improved meals service and reduced food waste and costs in medical institutions resulting from employment of a food service dietitian - a case study.

BACKGROUND: A recurring problem in medical institutions is patients not always receiving food meeting their nutritional and medical needs. A proposed contributing factor is non- inclusion of dietitians in food service staff. Recently, positions for food service dietitians in hospitals were created. For the newly defined role of "Food Service Dietitian", comprehensive training courses were developed (70 dietitians participated). OBJECTIVE: To examine the impact of the addition of the role of a "Food Service Dietitian" in medical institutions on suitability of foods served, food costs and food waste. METHODS: A three years (2014-2017) national case study to examine the new role's impact was carried out, in 18 hospitals, nine of which employ a food service dietitian (intervention), and 9 without (control). The number of nutritional analyses of menus was checked, as was the extent of kitchen staff training, and how often night meals were served for all patients. Data were gathered regarding food costs and waste with respect to food distributed to staff and patients. Food costs savings and waste reduction were calculated, based on reduction in provision of unnecessary meals, at a cost of 18 NIS per day per meal. RESULTS: Kitchen staff training was carried out in all intervention institutions, and not in the controls. In most controls, nutritional analyses were not performed, whereas in the intervention hospitals, full analyses were performed and tailoring of menus to specific department requirements improved significantly. In most intervention hospitals, late night snacks were provided, this not being so in the controls. Total food cost savings of $229,569 per annum was seen in the six intervention hospitals, attributable to 4 factors: 1.Meals not delivered to fasting patients, or those receiving parenteral/enteral nutrition- cost savings of 328,500 NIS ($93,857)2.Better tailoring and monitoring of food delivered to the wards and staff (bread, cheese, milk etc)- annual cost savings of 235,000 NIS ($67,142) in the hospitals with a food service dietitian.3.Checking expiry dates of medical foods, and improved communication between the wards, the kitchen and the food distribution centers, has lessened food waste with savings of 5% from the medical food budget per annum of 40,000 NIS ($11,428).4.As a result of dietitian-performed nutritional analyses, tailoring of food provided according to the patient's medical and nutrition needs was improved. In one hospital, after re-evaluation of serve sizes in high protein diets, sizes were reduced while retaining adequacy, with immediate cost savings of 200,000 NIS ($57,142) per annum. CONCLUSIONS: Implementation of the new role of Food Service Dietitian led to cost savings and significant improvements in adherence to the nutritional care plan.

Nutrition care quality indicators in hospitals and nursing homes: A systematic literature review and critical appraisal of current evidence.

OBJECTIVE: Quality indicators (QIs) can be used to assess and improve the quality of care in health care institutions. Although QIs about nutrition care in hospitals and nursing homes have been used in studies, no systematic catalogue exists to date. This systematic literature review identifies nutrition care QIs in hospitals and nursing homes and maps them according to QI type, stakeholder level and nutrition care theme. We also assess the level of consensus between studies and critically appraise the QIs presented therein based on two conceptual frameworks. METHODS: Ovid, Scopus and grey literature were searched from 1995 to 2016 including studies in English and German. Papers were considered if they presented, developed, assessed, rated or applied nutrition care QIs in hospitals or nursing homes. We used Donabedian's framework to define structure, process and outcome indicators, the WHO (World Health Organization) definition to describe stakeholder levels, and a structured table to map indicators within themes. Further, we used the Institute of Medicine (IOM) and the Organisation for Economic Cooperation and Development (OECD) frameworks' key dimensions to measure the conceptual quality of the QIs. Results are summarised and presented tabulated and narratively. RESULTS: From 536 identified studies, 46 were included. Eight hundred and twenty-two QIs were extracted and mapped into 19 themes and 151 sub-themes. Half were process indicators (49%) and about a quarter were outcome (28%) and structure (23%) indicators, respectively. The vast majority (71%) targeted micro level, while 28% meso level and only 1% macro level information. The nutrition themes meals/mealtimes (12%), treatment (adherence) (12%), nutrition screening (7%), assessment (7%) and monitoring (7%) were most frequently covered. 69% of indicators were cited by more than one study. Most frequent framework dimensions were patient-centeredness (33%), timeliness (30%), validity (30%) and actionability/feasibility (30%). CONCLUSION: The large number of nutrition care QIs in hospitals and nursing homes indicates the high interest in and importance of better nutrition care provision in institutions. However, the great variability indicates little consensus of the nutrition community on how to best assess and measure the quality of nutrition care. The limited methodological and conceptual validity of presented QIs and the low representation of QIs at macro and meso levels make international consensus finding complicated. Increased efforts including all stakeholder levels and using conceptual frameworks to define a limited number of key QIs with high methodological validity, actionability and stakeholder relevance are needed. Registration in clinicaltrials.gov: Identifier: NCT02820246.

The quest to improve the quality of hospital food for patients.

Emeritus Professor Alan Glasper, from the University of Southampton, discusses an initiative by the Government to review and improve the nutritional quality of hospital food.

The quest to improve the quality of hospital food for patients.

Emeritus Professor Alan Glasper, from the University of Southampton, discusses an initiative by the Government to review and improve the nutritional quality of hospital food.

Hospital food: raise standards, cut costs.

Sam Foster, Chief Nurse, Oxford University Hospitals, reflects on the problems of ensuring the quality of hospital food and examines the latest Government initiative to reduce costs.