Work site food purchases among healthcare staff: Relationship with healthy eating and opportunities for intervention

AIM: The current study describes food‐purchasing behaviours of healthcare staff, determines whether purchasing food at work is associated with overall indicators of healthy eating, and explores opportunities for improving the hospital food environment. METHODS: A secondary analysis of a health and wellbeing survey of healthcare workers (n = 501) in Queensland, Australia. Multiple regression models describe the associations between food purchases and indicators of healthy eating, while controlling for age, gender and work role. RESULTS: More than 60% of staff purchased food/drinks at work in the past week, and this was inversely associated with indicators of healthy eating. For example, among those purchasing food/drinks at work on most days, only 18% reported their overall diet as excellent or very good, compared to 50% of those who do not purchase food/drink at work (odds ratio [OR] = 0.24; 95% confidence interval [CI] = [0.12,0.48] in adjusted models). Staff feedback prioritised strategies to make healthy meals more accessible and affordable. CONCLUSION: Improvements to the retail food environment in hospitals could have a positive impact on the overall nutritional wellbeing of staff

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

Implementation of gestational weight gain guidelines - what’s more effective for ensuring weight recording in pregnancy?

Background: Pregnant women who gain weight in accordance with guidelines have the lowest risk of pregnancy and birth-related complications. However, evidence-practice gaps often exist. To address pregnancy weight management barriers, a stepped implementation science approach was used, comprising targeted in-services, provision of scales for clinic rooms, and changes to routine weight recording in a hospital electronic medical record. The aim of this study was to assess the cumulative influence of evidence-based interventions on staff's compliance to recording of antenatal weights. Methods: Retrospective data analysis of weight recording over three 15-month cohorts across April 2014-December 2017. Variables calculated from data included: proportion of women with weight recorded at booking and proportion of women who had a weight recorded at each visit. Generalised estimating equation modelling was used to examine differences in weight recording compliance rates between cohorts, pre-pregnancy body mass index categories, model of care and clinicians. Results: There were approximately 13,000 pregnancies in each cohort. The proportion of women who had a weight recorded at each visit per cohort differed significantly between cohorts from 4.2% (baseline), 18.9% (scales and in-services) to 61.8% (medical record prompts), p < 0.001. Conclusion: Significant improvements were achieved through systematic barrier analysis and subsequent mapping and implementation of appropriate and effective interventions. Improvements were observed across the entire service, in all models of care with all professional groups demonstrating increased recording of weights

Re-evaluating the nutritional awareness, knowledge and eating behaviours of women attending a tertiary maternity hospital following iterative service redesign

Aim: Since the opening of the new Mater Mothers' Hospital in 2008, innovative initiatives were developed, implemented and evaluated to meet women's nutritional needs. This study evaluated changes in women's nutritional awareness, knowledge and behaviours and compared these data with our baseline survey. Methods: During 2014–2017, 421 postnatal women were surveyed across nine survey periods. Results were compared with those from our 2008 survey (n = 102). Surveys assessed nutrition knowledge, attitudes, behaviour, education preferences, and dietetic service awareness and were distributed on meal trays. Results: A greater proportion of women accessed the nutrition services in 2014–2017 compared with 2008 (19.7% vs 9.9%) and rated the resources favourably (≥3.5 out of 5). A similar proportion rated the importance of eating well postnatally (83.1% vs 92.1%) and returning to their pre-pregnancy weight (62.4% vs 68.3%) as important/very important. In both periods, women had poor diet quality, despite identifying healthy eating as a high priority. A reduction in median gestational weight gain (GWG) approached significance, 13.0 kg (2014–2017) versus 14.0 kg (2008), P = 0.055. There was a significant association between GWG and cohort with an increase in the proportion of women gaining within their correct guidelines (by 15.4%), a reduction of excessive gain (by 24.7%, P < 0.001) over time. Conclusions: Evidence-based service changes made since 2008 have effected positive change in women's GWG, service preferences, and access. However, women still require awareness-raising and behaviour change programs to improve diet quality and GWG to ensure optimal pregnancy outcomes

Evaluation of a process of implementation of a gestational diabetes nutrition model of care into practice

Aim: Poorly controlled gestational diabetes mellitus can result in negative pregnancy and delivery outcomes. A reduced need for insulin was documented in the validation of American gestational diabetes Nutrition Practice Guidelines, which recommend at least three dietitian visits. No Australian gestational diabetes mellitus nutrition guidelines exist. This paper evaluates the implementation of a dietetic model of care based on the American guidelines in an Australian hospital. Methods: The implementation plan consisted of a nine-month pre (usual care)/post (new model of care) design with a month for ‘integration’ across 2012–2013. Primary outcomes were uptake of the new dietetic model of care and requirement for pharmacotherapy. Results: Both phases ran for seven months; integration required four months. Pre-intervention, only one woman received a review appointment. Significantly more women received best-practice care post-implementation (P = 0.02); of the 162 women seen, 50.6% received two review appointments. As a result of heavy clinical demand, only 31.5% of the women seen post-implementation received an individual dietitian assessment and education session, deviating from best practice. Clinically relevant changes were seen in medication requirements with a decrease in women requiring pharmacological treatment (31.1% (pre); 26.9% (post)). The difference was more pronounced in women who received best-practice care (27.2% (no) vs 25.0% (yes)). Conclusions: This project successfully increased the proportion of women seen according to best practice. Service limitations impaired the delivery of optimal care. The present study illustrates the opportunities and challenges of conducting evidence-based implementation research in routine clinical care