Linda J. Lafferty

Current and Future Practices in Hospital Foodservice

OBJECTIVES To identify current operational practices and expectations for future practices in hospital foodservice; establish the probability that current practices will change; and determine whether differences in practices exist on the basis of profit status and hospital size. DESIGN A questionnaire, to determine current practices, probability of change, and expectations for future practices, was mailed to foodservice directors. SUBJECTS A random sample of 500 foodservice directors in US hospitals with 200 or more beds. A total of 214 questionnaires were returned for a response rate of 43%. STATISTICAL ANALYSIS Descriptive statistics were used to report current practices, probability of change, and expectations for future practices. The Kruskal-Wallis test was conducted to examine whether the probability of change ratings differed on the basis of hospital profit status and size. chi 2 Analysis was used to examine whether expectations for future practices differed based on hospital profit status and size. RESULTS Currently 81% of hospital foodservice departments have fewer than 100 employees; 73% have revenue budgets of less than

Can Patient-Written Comments Help Explain Patient Satisfaction with Food Quality?

2 million; 49% have expense budgets greater than

A survey of perceived benefit and differences in therapy provided by credentialed and noncredentialed nutrition support dietitians.

2 million; 55% use a selective menu, often (43%) 1-week in length; 74% use conventional food production technology; 81% have a centralized, hot tray line; 91% operate a cafeteria; 96% do on-site catering; 69% have differential pricing for employee meals; 58% have subsidized employee meals; and 19% have coffee kiosks. Changes in current practices are expected in several areas. Foodservice directors expect to serve meals to fewer inpatients (71%), employ less staff (73%), have smaller expense budgets (70%), and generate more revenue (61%). Kruskal-Wallis and chi 2 analyses indicated few differences on the basis of hospital profit status and size. There was little consensus among directors on how to best respond to these environmental changes. APPLICATIONS Hospital foodservice practices will change in the future. Foodservice directors are using a variety of strategies (e.g., revenue-generating ventures, menu changes) to respond to current environmental changes. Increased emphasis will be placed on running a hospital foodservice department as a profit center rather than a cost center.

Timely Resolution of Patient Concerns Improves Post-Discharge Satisfaction

This study identified themes in patient-written comments about meals served in a hospital and determined the relationship of those themes to patient food-quality satisfaction ratings among medical and surgical patients. Data from 2 years of quantitative Press Ganey patient-satisfaction ratings and qualitative comments related to meals by 1,077 patients discharged from a Midwest urban medical center were reviewed retrospectively. Themes in comments were identified. Results indicated that patient satisfaction with food quality did not differ based on sex or age, but did differ based on length of stay, perceived health status, and whether a patient provided written comments or not. The most common comments focused on the temperature of hot food, receiving what was ordered, and satisfaction with foodservice staff. The tenor of comments differed by food-quality rating given. Overall food quality rating was best predicted by food-related comments rather than comments about staff, or other issues not addressed in the Press Ganey quantitative questionnaire.

Registered Dietitian Prescriptive Practices in Hospitals

BACKGROUND Benefits of the certified nutrition support dietitian (CNSD) credential to clinicians, their patients, and healthcare administrators have not been defined. A study was designed to measure the difference in cost of therapy provided by credentialed and noncredentialed nutrition support dietitians and to measure the perceived value of the credential to those who hold it. METHODS Using a modified Delphi technique, a questionnaire was developed to obtain demographic information, responses to statements of perceived benefit of the credential, and costs of therapy selected for patients in common clinical scenarios. RESULTS Of the 691 questionnaires mailed, 314 (45%) were returned. For 8 of 10 statements of perceived benefit, mean response scores indicated agreement. Respondents did not agree that salary increases resulted from credentialing. There was no difference between groups in the type of monitoring selected or in the time to complete an initial assessment. Cost of therapy was significantly higher for credentialed versus noncredentialed dietitians (dollar 915.67 +/- dollar 241.73 versus dollar 851.78 +/- dollar 243.44; p = .035), although the survey was not designed to show that the most appropriate care was least expensive. CONCLUSIONS The CNSD credential is of perceived benefit to practitioners except in obtaining salary increases. Credentialed dietitians selected more expensive therapy than noncredentialed dietitians, which would benefit healthcare administrators only if reduction of other costs resulted. More complex models are needed to fully assess the benefit of credentialed nutrition support dietitians to patients and healthcare administrators.

comparison of Three Enteral Product Distribution Systems to Determine Methods to Reduce Waste.

This research examined the effectiveness of a Food and Nutrition Services (FNS) Patient Advocate program on post-discharge patient satisfaction. All inpatients (n=187) who rated their satisfaction with one or more of six FNS attributes as 3 or lower (on a 5-point scale) during a 4-month time period were visited by the FNS Patient Advocate, as were other patients on the units. A questionnaire similar to the inpatient satisfaction questionnaire was sent post-discharge to patients visited by the FNS Patient Advocate (n=374); a total of 158 (42%) responded. Results indicated that most patients (73%) recalled their interaction with the FNS Patient Advocate and were highly satisfied with their interaction with the Advocate (mean=5.8 on 7-point scale). Comparison of inpatient and post-discharge ratings of satisfaction indicated a significant improvement in ratings post-discharge for special/restricted diet explained (P<0.01), food temperature (P<0.001), food quality (P<0.001), courtesy of server (P<0.01), and likelihood of receiving ordered foods (P<0.01) by inpatients who gave ratings of 3 or lower for any item and were seen by the FNS Patient Advocate. Addressing patient concerns while the patient is in the hospital appeared to be an effective strategy in improving satisfaction ratings of those patients post-discharge.

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

The objective of this cross-sectional study was to describe the level of prescriptive authority and explore barriers to obtaining prescriptive authority of registered dietitians in acute health care facilities. A sample of 1,500 clinical nutrition managers was electronically surveyed; data from 351 respondents (23% response rate) were analyzed using descriptive statistics and chi(2) tests. Many (54%) respondents reported no prescriptive authority, 36% reported dependent prescriptive authority, and 10% reported independent prescriptive authority. Most (95%) respondents with no prescriptive authority and (89%) with dependent prescriptive authority valued independent prescriptive authority. The two most commonly listed barriers to independent prescriptive authority were opposition (52% no prescriptive authority, 48% dependent prescriptive authority) and liability (40% no prescriptive authority, 48% dependent prescriptive authority). Forty-five percent of respondents with independent prescriptive authority reported the route to independent prescriptive authority was via clinical privileges. Based on the responses of this sample, the authors conclude the majority of respondents do not have, but value, independent prescriptive authority. The issue of liability as a barrier to independent prescriptive authority might need further study to determine reasons why liability is perceived as a barrier to independent prescriptive authority.

Are Registered Dietitians Adequately Prepared to Be Hospital Foodservice Directors

Abstract With increasing use, costs of enteral products are an increasing portion of the foodservice budget. Additional costs are incurred if systems for distributing enteral products throughout the hospital result in waste. A study was designed to compare three enteral product distribution systems to determine if waste could be reduced. In addition, labor time and nursing satisfaction were measured for each system. The present system consisted of product delivery to the bedside daily based on physician order. An alternate system involved product delivery as floor stock to locked nourishment rooms on each nursing unit. The second alternate system consisted of product delivery to a locked cabinet accessed with a coded computer keypad. Alternate systems were trialed on two patient care units with a high volume of enteral product use. To control for differences in units, a crossover design was used. Data collection lasted for two weeks following a one week acclimation period between methods. Formula ordered, amount dispensed, patient intake, and stocking time were recorded daily. Daily waste, percent intake, percent dispensed, and percent wasted were calculated. Analysis of variance was used to compare variables for each delivery system. Each of the alternate systems significantly reduced product dispensed and product wasted (p≤0.05). Alternate systems also required less labor and resulted in higher nursing satisfaction ratings (p≤0.05). Based on these results, delivery of enteral products to a central location on the nursing unit rather than to the patient bedside reduced waste and improved nursing satisfaction.

Position of the American Dietetic Association

Abstract 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.