An examination of nutrition informatics in hospital foodservices and the eHealth readiness of dietitions: Are dietitians ripe for disruption?

Technology has rapidly advanced over recent decades, and despite the healthcare environment lagging in technology adoption, it is now accepted as integral for improving efficiencies, reducing costs, supporting research and ultimately enhancing patient care. As with healthcare more broadly, the Australian dietetic workforce is also lagging with technology adoption and involvement, therefore a study examining this area is both timely and warranted. The hypothesis examined in this thesis was that nutrition informatics could provide valuable benefits for dietitians, however the dietetics profession is not yet sufficiently ready for eHealth opportunities. This thesis explores this topic using a mixed-methods approach across three key phases, investigating from several perspectives..

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\u3c0.05. 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 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

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\u27 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

Nutrition care benefits of a bedside spoken meal ordering system compared to a paper menu

Malnutrition in hospitals has been well documented in Australia and internationally. Bedside meal ordering systems (BMOS) have the potential to improve patient nutritional care and have been endorsed in Australia and the United States, but there are few published evaluation studies. This study aims to evaluate the effect of a BMOS compared to a paper menu. Outcome measures include: nutritional intake (energy and protein), patient satisfaction, Nutrition Assistant face-to-face time with patients and cost. Baseline data for the paper menu system was collected from 54 consenting patients (58% rate) across five wards at a 210 bed tertiary hospital in Sydney, during September 2011. 69% of patients consumed \u3e50% of their meals over a 24 hour period, with 59% consuming all of breakfast, compared to 44% and 34% consuming all of lunch and dinner respectively. 59% rated overall food satisfaction as ‘very good’; however there was a lack of awareness of the Nutrition Assistants and their roles in menu assistance and dietary guidance. High scores for meal taste, menu variety, expectations and overall satisfaction were associated with a ≥50% intake. The only patient variable linked to an increased satisfaction was age ≥70 years. Observations of Nutrition Assistants identified \u3c1 minute was spent with 88% of patients. A BMOS implementation is planned for February 2012, and post-implementation data will be compared with baseline. Our hypothesis is that having a Nutrition Assistant using a BMOS could increase patient satisfaction and address the deficits in patient knowledge to consequently improve patient dietary intake

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

Engaging the patient: improving dietary intake and meal experience through bedside terminal meal ordering for oncology patients

Background The present study aimed to determine changes in patient dietary intake, plate waste and meal experience associated with the implementation of a patient‐directed bedside electronic meal ordering system (BMOS) compared to traditional paper menus (PMs). Methods The study evaluated the effect of a BMOS compared to PM at an oncology hospital between 2015 and 2016. Patient dietary intake, plate waste and patient meal experience were the key outcomes measured. Plate waste was determined using a validated seven‐point visual wastage scale. The weight eaten estimates were converted into nutrients consumed in each food item to estimate dietary intake. Patient meal experience was measured via written surveys. Results There was an increase in patient dietary intake and patient meal experience, with BMOS compared to PM. Comparison between BMOS (n = 105) and PM (n = 96) showed statistically significant increases in ordering sufficient energy (8683 kJ day−1 versus 6773 kJ day−1, P = 0.004) and protein (97 g day−1 versus 82 g day−1, P = 0.023), as well as average energy intake (6457 kJ day−1 versus 4805 kJ day−1, P \u3c 0.001) and protein intake (73 g day−1 versus 58 g day−1, P \u3c 0.001). Average plate waste remained the same for both cohorts. Patient meal experience showed that 60% of patients accessed the BMOS independently. The BMOS cohort had significant increases in receiving the food that they ordered (P \u3c 0.001) and in choosing food that they liked (P = 0.006). Conclusions The results of the present study demonstrate that a patient‐directed electronic meal ordering system improved patient dietary intake and meal experience. These results are most likely a result of empowering patients to make decisions about their meal selections and nutritional care through accessible meal ordering and improved menu communication

Patient nutritional intake increases with a bedside spoken meal ordering system

Abstract of paper presented at the Dietitians Association of Australia 30th National Conference, 23-25 May 2013, National Convention Centre, Canberra, Australia

Bedside Menu Ordering System increases energy and protein intake while decreasing plate waste and food costs in hospital patients

This study aimed to evaluate the impact of changing from a traditional paper menu ordering system (TM) to a BMOS on the key outcome measures of nutritional intake, plate waste, patient and staff satisfaction and patient food costs

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\u27 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 \u3c 0.05. No additional time was required for the NA role, however direct patient interaction increased significantly (p \u3c 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