Patient Food Ordering Methods Practiced in Canadian Hospitals
Conventional Ordering Method – while slowly becoming an archaic method, we do still see cases of passing meal plans ( a daily menu selection sheet) to patients for them or family members to select meal components for breakfast, lunch, dinner. They do this using a sheet of paper with the menu printed on it, a pen, and circle the things they want following strict guidelines as noted on the paper. They often do this about 2 days in advance of the actual menu day they are selecting. Of course, this system has its many disadvantages such as and not limited to:
– poor control as patients may actually not be at the hospital two days after they fill in their sheet
– manual and labor intense system for the diet office
– poor control over diet therapy as many mistakes can happen
– patient forgets what they selected and this can lead to poor satisfaction ratings overall
– high food cost due to waste through poor forecasting methods
– diet changes are manual and thus more labor wasted to track and correct menu plans
This system is often applicable to hot serve locations and can be developed using a long cyclical menu of up to 3 weeks. Meal service times are what we call ‘protected’ and thus happen at regularly scheduled times throughout the day – this helps with production logistics as well as keeps the unit level ward staff happy that they follow a set schedule of activity each day.
Selective Menus but Modernized – the patient selects their meal by using a daily menu planner as above, but the information is then inputted into a computer and the diet office then uses a computer software program such as CBORD or COMPUTRITION to tally and talk to production as well as trayline. Proper tray tickets are printed according to the beltline set up and diet therapy integrity checks are done within the software so that patient selections match diet orders. This system is most common now at facilities that are still hot plating although we do see this at cold plating locations. It is still manually intensive and patients may choose meals the day before so there is still a loss of control by the patient which can impact satisfaction. Menus are often developed in 2 week cycles. Meal service times are what we call ‘protected’ and thus happen at regularly scheduled times throughout the day – this helps with production logistics as well as keeps the unit level ward staff happy that they follow a set schedule of activity each day. We are seeing a small resurgence of the selective menu through the use of technology whereby patients can select what they want during a bedside interview by a diet tech or food service worker who enters selections into a palm device but this is rare at the moment.
Non Selective Menus – here we have the use of a computer software system like mentioned above. The system integrates with the hospital’s ADT System (admission, Discharge, Transfer) and thus keeps tabs on who is in the house and who is not. In addition, the system will connect with the hospital patient record info and inform the dietary department when a diet change has been ordered. The intriguing thing about this system is that it is built on the premise that the patient preferences are determined at admission. Here, a series of questions are asked of the patient to determine likes and dislikes as well as allergies etc. The menu plan is fixed with alternates available for main entrée dishes as well as some juices and other easy food items. The patient never fills in a menu card. The system chooses what the patient gets based on likes and dislikes. An example – the patient says they do not like Tomato Sauce and Apple Juice – and on Tuesday the menu says that Breakfast is Scrambled egg, Muffin, and Apple Juice…they will be given an orange juice instead. At lunch the menu says that a Lasagne will be served and seeing the patient does not like Lasgane they will receive an alternate which that day is a Tuna Sandwich. The majority of cold plating locations use this system and it is predominant in ‘regional food service models’ where large numbers of patients are served from one central location. Menus are often developed for 2 week cycles however we are seeing more and more 7 day menu cycles emerging. Meal service times are what we call ‘protected’ and thus happen at regularly scheduled times throughout the day – this helps with production logistics as well as keeps the unit level ward staff happy that they follow a set schedule of activity each day.
Spoken Menu – There are two versions that we see of Spoken Menu here in Canada. The first is the use of a mobile trolley that has a combination of bulk and portioned foods which is taken throughout a ward for meal service and used as a local assembly system for trays. The second is assembling trays outside the ward in a pantry or centrally in a kitchen based on a patient selection from the previous meal.
In Bulk Meal Trolley Service we see a bulk trolley of food set up outside patient rooms in the hall or at a nearby pantry – the bulk trolley is stocked with regular items such as juices, milks, condiments etc but is also stocked with other hot and cold foods that have been made for that day following a menu for the week. The server enters the patient room and verbally asks what they would like for their meal. The patient selections from the trolley are checked with patient diet orders for compliance, the tray is assembled, and the patient receives their tray within 3 minutes. This is a great system (often used in the UK ) and can drive patient satisfaction very high. Key concerns are labor to do the meal service, space at ward level, infection control procedures, and food control over waste. Good forecasting techniques must be in place to make this system a success. It can be done using bulk food trolleys or even pre-plated meal entrees. There are advantages and disadvantages to both. Meal service times are what we call ‘protected’ and thus happen at regularly scheduled times throughout the day – this helps with production logistics as well as keeps the unit level ward staff happy that they follow a set schedule of activity each day. The spoken menu can also be put into place for ambulatory patients who can eat at a dining room within the hospital.
In Tray Assembly in a pantry or central kitchen we take the order at the patient bedside at the end of a meal (say breakfast ) and using a hand held device (or a low tech solution such as a pen and paper), take the order from the patient of their next meal. The hand held then sends the info to the kitchen immediately, or, when the worker goes back to the kitchen, the order is uploaded via a sync feature. The tray can then be put together in the kitchen close to meal service and then served. Tray assembly can be cold or hot. Tray assembly utilses a new style of meal assembly at a series of work cells specially designed for tray assembly in healthcare foodservices. These B-Lean Stations will help improve efficiency and working conditions for staff.Food trays can be placed inside retherm tray carts (Novaflex or B-Pod) or, in a hot line method where the food being plated is hot, an active temperature maintenance system can be used to keep food trays at optimum temperatures while other trays are being prepared (the RTS or Ready to Serve).
Room Service – here we have the patient ordering their meals at any time of the day (within a set timeframe such as 6 am – 6 pm). They can order using touch screens or via telephone and the order from a Room Service Menu like you would find in a hotel room. The meal is brought to them within 45 mins of ordering. Here we still need a computerized diet office that will check the patient order against diet orders, track food being produced, and expedite order to various stations within the central kitchen. We normally see the Room Service Models alongside traditional cook serve with ‘a la minute’ tray assembly , however we are seeing some hybrids developing that make use of chilled or frozen foods. While this new service is intriguing and is seen as innovative and customer focused, the system is labor intensive, can be costly on food if waste occurs, and logistically can tie up the hospital in a knot it never anticipated – for example, without protected meal times, staff from the kitchen now run meals to wards throughout the entire day at unscheduled times due to patient demand and elevators can get very tied up unless the hospital has dedicated service desire lines of transport. The system can also tax staff as they work to demand which can fluctuate each day – staff normally want their jobs to be structured and like routine. In Canada, we see Room Service emerging for special populations such as OBS (Maternity) or Rehab. It is not a system to put in place in surgical wards – who will call the order down ?
There are a number of other ‘hybrid’ type models that can be cited but the aforementioned does cover the majority. The hybrids take one of the above and tweak it normally because of site conditions such as patient population types, physical structure, capital available, nursing responsibilities at ward level, program management approaches etc. I think if there is a need of further insight into this, you should connect with CBORD, VISION, COMPUTRITION or another diet office software supplier who I am sure would give you a great historical review as well as what is available now and what is coming .
