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

AIM: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Implementation of an electronic solution to improve malnutrition identification and support clinical best practice.

BACKGROUND: Routine malnutrition risk screening of patients is critical for optimal care and comprises part of the National Australian Hospital Standards. Identification of malnutrition also ensures reimbursement for hospitals to adequately treat these high-risk patients. However, timely, accurate screening, assessment and coding of malnutrition remains suboptimal. The present study aimed to investigate manual and digital interventions to overcome barriers to malnutrition identification for improvements in the hospital setting. METHODS: Retrospective reporting on malnutrition identification processes was conducted through two stages: (1) manual auditing intervention and (2) development of a digital solution - the electronic malnutrition management solution (eMS). Repeated process audits were completed at approximately 6-monthly intervals through both stages between 2016 and 2019 and the results were analysed. In Stage 2, time investment and staff adoption of the digital solution were measured. RESULTS: Overall, the combined effect of both regular auditing and use of the eMS resulted in statistically significant improvements across all six key measures: patients identified (97%-100%; p < 0.001), screened (68%-95%; p < 0.001), screened within 24 h (51%-89%; p < 0.001), assessed (72%-95%; p < 0.001), assessed within 24 h (66%-93%; p < 0.001) and coded (81%-100%; p = 0.017). The eMS demonstrated a reduction in screening time by over 60% with user adoption 100%. Data analytics enabled automated, real-time auditing with a 95% reduction in time taken to audit. CONCLUSIONS: A single digital solution for management of malnutrition and automation of auditing demonstrated significant improvements where manual or combinations of manual and electronic systems continue to fall short.

Validation of an electronic food intake tool and its usability and efficacy in the healthcare setting.

BACKGROUND: Accurate dietary intake data are critical to nutrition care planning. Commonly used food record charts (FRC) are paper-based, time consuming, require nutrient analysis estimations, and may provide limited accuracy. The present study aimed to validate Mobile Intake® (MI) (an electronic food intake tool incorporating the five-point visual scale and providing automatic nutrient analysis) for usability and efficacy in quantifying dietary intake in the healthcare setting. METHODS: Two research stages within two tertiary hospitals included: (1) examining criterion validity and efficiency of dietary intake quantification using FRC and MI compared to the gold standard weighed food record (WFR) in a controlled environment and (2) comparing efficiency and effectiveness of FRC and MI in usual care conditions. RESULTS: In Stage 1, dietary intake was calculated (n = 90) with a significant difference across all methods (FRC, MI and WFR) for energy (p = 0.04), but not between MI and WFR (p = 1.00). The time taken for MI (40 s) was significantly less than FRC (174 s) and WFR (371 s) (p < 001). In Stage 2, dietary intake was determined (n = 210) using FRC and MI. Sufficient data to complete dietary analysis were available for 35% of meals from FRC compared to 98% from MI. Calculated mean daily energy intake (4764 ± 1432 kJ vs. 6636 ± 2519 kJ, p = 0.002) and mean daily protein intake (62.9 ± 12.7 g vs. 78.5 ± 22.2 g, p = 0.007) were significantly lower with FRC compared to MI. Average time to complete MI was 14.4 seconds. CONCLUSIONS: MI demonstrates efficacy as an accurate measure of dietary intake compared to WFR, as well as usability, providing faster, more accurate and comprehensive real-time intake data in practice than FRC.

Impact of electronic bedside meal ordering systems on dietary intake, patient satisfaction, plate waste and costs: A systematic literature review.

AIM: Hospital foodservices provide an important opportunity to deliver valuable dietary support to patients, address hospital-acquired malnutrition risk and enhance patient satisfaction. Modifying the meal ordering process through the adoption of technology may actively engage patients in the process and provide an opportunity to influence patient and organisational outcomes. This systematic review was undertaken to evaluate the impact of electronic bedside meal ordering systems in hospitals on patient dietary intake, patient satisfaction, plate waste and costs. METHODS: A systematic search following PRISMA guidelines was conducted across MEDLINE, CINAHL, EMBASE and Web of Science for randomised controlled trials and observational studies comparing the effect of electronic bedside meal ordering systems with traditional menus on dietary intake, patient satisfaction, plate waste and cost. The quality of included studies was assessed using the Quality Criteria Checklist for Primary Research tool. RESULTS: Five studies involving 720 patients were included. Given the heterogeneity of the included studies, the results were narratively synthesised. Electronic bedside meal ordering systems positively impacted patient dietary intake, patient satisfaction, plate waste and costs compared with traditional menus. CONCLUSIONS: Despite the increase in healthcare foodservices adopting digital health solutions, there is limited research specifically measuring the impact of electronic bedside meal ordering systems on patient and organisational outcomes. This study highlights potential benefits of electronic bedside meal ordering systems for hospitals using traditional paper menu systems, while also identifying the need for continued research to generate evidence to understand the impact of this change and inform future successful innovations.

Strategic leadership will be essential for dietitian eHealth readiness: A qualitative study exploring dietitian perspectives of eHealth readiness.

AIM: To explore dietitians' perspectives on the eHealth readiness of Australian dietitians, and to identify strategies to improve eHealth readiness of the profession. METHODS: Dietitians who met the criteria for nutrition informatics experts participated in semi-structured interviews between June 2016 and March 2017. The interviews were recorded and transcribed verbatim. Thematic analysis using coding was undertaken until consensus was reached by the researchers regarding key themes, topics and exemplar quotes. RESULTS: Interviews with 10 nutrition informatics experts revealed 25 discussion topics grouped into four main themes: benefits of eHealth for dietitians; risks of dietitians not being involved in eHealth; dietitians are not ready for eHealth; and strategies to improve eHealth readiness. The strategies identified for improving eHealth readiness included: collaboration and representation, education, offering of incentives and mentoring, as well as development of a national strategy, organisational leaders, nutrition informatics champions and a supportive environment. CONCLUSIONS: These findings suggest that dietitians may not be ready for eHealth. Strategic leadership and the actioning of other identified strategies will be imperative to preparing dietitians for eHealth to ensure the profession can practice effectively in the digital age, optimise nutrition care and support research for eHealth. If dietitians do not engage in eHealth, others may take their place, or dietitians may be forced to use eHealth in ways that are not the most effective for practice or maximising patient outcomes.

A framework for eHealth readiness of dietitians.

AIM: To develop a framework for assessing the eHealth readiness of dietitians. METHODS: Using an inductive approach, this research was divided into three stages: 1. a systematic literature review to identify models or frameworks on eHealth readiness; 2. data synthesis to identify eHealth readiness themes and develop a framework; and 3. semi-structured interviews with Australian nutrition informatics experts to gain consensus and validate the framework. RESULTS: Two hundred and forty one unique citations were identified, of which twenty four met the research criteria and were included in the review and subsequent synthesis. Common eHealth readiness themes or dimensions were extracted from the literature, and five key dimensions were identified that were relevant to dietitian eHealth readiness: access, standards, attitude, aptitude and advocacy. A framework diagram was designed and discussed during semi-structured interviews with ten nutrition informatics experts to inform the final framework. The result of this research was an inductively developed Framework for eHealth Readiness of Dietitians (FeRD). DISCUSSION: The FeRD builds on existing theories and models, and provides a conceptual model for developing eHealth readiness evaluation tools to examine, measure and drive strategies to better prepare dietitian professionals for eHealth.

Room Service Improves Nutritional Intake and Increases Patient Satisfaction While Decreasing Food Waste and Cost.

BACKGROUND: Room service is a foodservice model that has been increasingly implemented across health care facilities in an effort to improve patient satisfaction and reduce food waste. In 2013, Mater Private Hospital Brisbane, Australia, was the first hospital in Australia to implement room service, with the aim of improving patient nutrition care and reducing costs. OBJECTIVE: The aim of this study was to comprehensively evaluate the nutritional intake, plate waste, patient satisfaction, and patient meal costs of room service compared to a traditional foodservice model. DESIGN: A retrospective analysis of quality-assurance data audits was undertaken to assess patient nutritional intake between a facility utilizing a traditional foodservice model and a facility utilizing room service and in a pre-post study design to assess plate waste, patient satisfaction, and patient meal costs before and after the room service implementation. PARTICIPANTS: Audit data were collected for eligible adult inpatients in Mater Private Hospital Brisbane and Mater Hospital Brisbane, Australia, between July 2012 and May 2015. MAIN OUTCOME MEASURES: The primary outcome measures were nutritional intake, plate waste, patient satisfaction, and patient meal costs. STATISTICAL ANALYSES PERFORMED: Independent samples t-tests and χ2 analyses were conducted between pre and post data for continuous data and categorical data, respectively. Pearson χ2 analysis of count data for sex and reasons for plate waste for data with counts more than five was used to determine asymptotic (two-sided) significance and n-1 χ2 used for the plate waste analysis. Significance was assessed at P<0.05. RESULTS: This study reported an increased nutritional intake, improved patient satisfaction, and reduced plate waste and patient meal costs with room service compared to a traditional foodservice model. Comparison of nutritional intake between a traditional foodservice model (n=85) and room service (n=63) showed statistically significant increases with room service in both energy (1,306 kcal/day vs 1,588 kcal/day; P=0.005) and protein (52 g/day vs 66 g/day, P=0.003) intake, as well as energy and protein intake as a percentage of requirements (63% vs 75%; P=0.024 and 65% vs 85%; P=0.011, respectively). Total mean plate waste decreased from 29% (traditional foodservice model) to 12% (room service) (P<0.001). Patient satisfaction ratings indicated improvement with room service across all Press Ganey meal scores: 68th to 86th percentile overall; 64th to 95th percentile for "quality of food"; and 60th to 99th percentile for "flavor of food." Evaluated during comparable times of the year, patient meal costs decreased by 15% with room service. CONCLUSIONS: A patient-centered foodservice model, such as room service, can improve patient nutritional intake and enhance patient satisfaction in a budget constrained health care environment.

Energy and protein intake increases with an electronic bedside spoken meal ordering system compared to a paper menu in hospital patients.

BACKGROUND AND AIMS: Electronic bedside spoken meal ordering systems (BMOS) have the potential to improve patient dietary intakes, but there are few published evaluation studies. The aim of this study was to determine changes in the dietary intake and satisfaction of hospital patients, as well as the role of the Nutrition Assistant (NA), associated with the implementation of an electronic BMOS compared to a paper menu. METHODS: This study evaluated the effect of a BMOS compared to a paper menu at a 210-bed tertiary private hospital in Sydney during 2011-2012. Patient dietary intake, patient satisfaction and changes in NA role were the key outcomes measured. Dietary intake was estimated from observational recordings and photographs of meal trays (before and after patient intake) over two 48 h periods. Patient satisfaction was measured through written surveys, and the NA role was compared through a review of work schedules, observation, time recordings of patient contact, written surveys and structured interviews. RESULTS: Baseline data were collected across five wards from 54 patients (75% response rate) whilst using the paper menu service, and after BMOS was introduced across the same five wards, from 65 patients (95% response rate). Paper menu and BMOS cohorts' demographics, self-reported health, appetite, weight, body mass index, dietary requirements, and overall foodservice satisfaction remained consistent. However, 80% of patients preferred the BMOS, and importantly mean daily energy and protein intakes increased significantly (paper menu versus BMOS): 6273 kJ versus 8273 kJ and 66 g versus 83 g protein; both p < 0.05. No additional time was required for the NA role, however direct patient interaction increased significantly (p < 0.05), and patient awareness of the NA and their role increased with the BMOS. CONCLUSIONS: The utilisation of a BMOS improved patient energy and protein intake. These results are most likely due to an enhancement of existing NA work processes, enabling more NA time with patients, facilitating an increase in patient participation and satisfaction with the service.