'On-Demand' snack service in a rehabilitation setting: Impact on satisfaction, intake, waste and costs.

AIM: To evaluate an 'On-Demand' snack service in a rehabilitation setting for satisfaction, intake, waste and cost. METHODS: In September 2021, a trial of an 'On-Demand' snack service was conducted on two general rehabilitation wards in a purpose-built rehabilitation hospital. A retrospective comparison of pre-implementation, 1-month and 8-month post-implementation audit data was used to evaluate staff and patient satisfaction, nutritional intake, waste and cost (labour and food). Descriptive and inferential statistical analyses were performed for intake quantitative data and content analysis was conducted for qualitative data. RESULTS: A total of 26 responses from staff and 34 from patients were received. Staff reported higher overall satisfaction with the 'tea-trolley' service (50% vs. 32%; χ2 6.815 [2]; p < 0.05). Patient satisfaction ratings of the original 'tea-trolley' system were higher than the 'On-Demand' snacks system (96% vs. 59%; χ2 41.60 [2]; p < 0.0001). Median daily intake from snack food and drinks was maintained (938 kJ and 6 g protein vs. 925 kJ and 6 g protein) and waste (23.3% vs. 20.9%; p < 0.05) decreased with the 'On-Demand' service. Cost of ordered food was similar ($778.15 'tea-trolley' vs. $746.1 'On-Demand'), however cost of waste ($179.47 'tea-trolley' vs. $128.7 'On-Demand') and labour ($1650.46 'tea-trolley' vs. $926.44 'On-Demand') reduced by 28% and 44%, respectively, with the 'On-Demand' snack service. CONCLUSION: Implementing an 'On-Demand' snack service in the general inpatient rehabilitation setting resulted in reductions in food waste, foodservice staff labour and waste costs, while intake was maintained. Patient and staff satisfaction decreased warranting further investigation into appropriate implementation methods.

Nutritional status and post-operative complications in patients undergoing surgery for advanced pharyngeal or laryngeal cancer.

PURPOSE: Malnutrition is an important prognostic indicator of post-operative outcomes in patients undergoing surgery for head and neck cancer, however, limited studies utilize validated nutrition assessment tools to accurately assess risk. The aim of this study was to determine the relationship between nutritional status on post-operative complications and length of stay for patients undergoing either a laryngectomy, pharyngectomy or pharyngolaryngectomy for head and neck cancer. METHODS: Patients with head and neck cancer undergoing a laryngectomy, pharyngectomy or pharyngolaryngectomy at a tertiary hospital in Australia were eligible for this retrospective cohort study (n = 40). Nutritional status was assessed by the dietitian on admission using the validated Subjective Global Assessment tool. Clinical outcomes were collected via retrospective chart review and included length of stay and post-operative complications. RESULTS: Pre-operative malnutrition incidence was 40%. Malnourished patients had higher incidences of any type of complication (57% vs 44%, p = 0.013) and pressure injury (86% vs 14%, p = 0.011) compared to well-nourished patients. Well-nourished patients had a clinically important shorter median length of stay compared to malnourished patients (17.5 vs 20 days). CONCLUSION: Early identification and management of malnutrition is essential to minimize risk of post-operative complications and reduce length of stay and should be considered a key component of prehabilitation programs.

Foodservice systems and mealtime models in rehabilitation: Scoping review.

AIMS: To describe current foodservice systems and mealtime care utilized in the rehabilitation setting. A secondary aim was to identify commonly used outcome measures in foodservice research in the rehabilitation setting. DESIGN: A scoping review. DATA SOURCES: PubMed, CINAHL, Scopus, Embase, PsycINFO and Cochrane were searched until January 2022. REVIEW METHODS: The review was conducted according to Joanna Briggs Institute's methodology for scoping reviews. Included studies were conducted in the inpatient rehabilitation setting, adult population ≥18 years old and provided a description of at least one element of the foodservice system, food and menu, waste and/or eating environment. RESULTS: Of 5882 articles screened, 37 articles were included, reporting 31 unique studies. Most rehabilitation units had cook-fresh production methods (50%), used decentralized bulk delivery methods (67%) had a communal dining room (67%) and had a 3-week menu cycle (71%). Mealtime care was predominantly provided by nursing staff, however few studies reported on specific activities. Nutritional intake was a key outcome measure across included studies (43%), with only six papers reporting on rehabilitation outcomes. Of the intervention studies (n = 9), all were aimed at improving nutritional intake through menu or mealtime care modifications; few (n = 3) studied changes in rehabilitation outcomes. CONCLUSION: This scoping review identified a considerable lack of reporting of foodservice and mealtime care systems used in rehabilitation settings in the available literature. Further investigation is required to understand what models of mealtime care are provided to patients and to understand the impact of changes to foodservice and mealtime systems on patient outcomes. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was necessary for this review.