Delivery Status
Late-tray solutions cut waste and improve patient satisfaction

By Margaret Sheridan, Senior Editor

With patient satisfaction a top healthcare priority, the tardy delivery of meal trays is a major challenge for foodservice managers at hospitals and care centers, says Paul Hysen, principal in a Northville, Mich.-based consultancy.

Late traysthose delivered out of sequence or schedule and most often replaced by a new servingcan result from early or late patient admissions, shortened stays or a change in diet order or guest appetite. The results: wasted food, increased costs and unhappy customers.

According to a 2001 National Society for Healthcare Foodservice Management survey of 100 members, late trays account for up to 16% of total patient meals. In hospitals with room service, spoken menus or hostess programs, the percentage drops to 5% or less. Hysen adds that a typical 400-bed hospital prepares 30 extra trays per meal to compensate for late deliveries, with food and labor costs per tray about $3 and $3.50, respectively. When you redeliver a second tray, youre into special delivery at double the cost, he adds.

When 650-bed Oakwood Hospital and Medical Center in Dearborn, Mich., switched from traditional tray-line service to room service with a universal menu, late-tray production, previously 30 to 60 per meal, was substantially reduced. Patients now phone their orders to diet clerks in the foodservice department who check each persons nutrition needs on a centralized computer. Servers deliver food from 6 a.m. to 10 p.m.

Two years after the transition to room service, Director of Food and Nutritional Services Dara Bross reports higher satisfaction among both patients and employees. And judging from what she sees on returned trays, food waste has decreased considerably while consumption is up. Cooks like the change. Theres less boredom and repetition than on a conventional tray line, she says.

LAG TIME
The primary foodservice issues are when and what patients want to eat, says Karen Smith, senior director for client programs and services for Atlanta-based Morrison Healthcare Food Services, a division of contractor Compass Group PLC. She finds that healthcare facilities report higher levels of customer satisfaction when patients take control of meal choices and time and type of delivery.

One client, 185-bed Boca Raton Medical Center in Boca Raton, Fla., opted for Morrisons Dining on Call, a system similar to hotel room service. A patient phones the call center and orders food from a menu in their room. There is no late tray because the meal arrives when requested, delivered by a catering associateon call via cell phone or pagerwho acts as a personal waiter.

Menus are available from 7 a.m. to 7:30 p.m. A maternity patient who wants a burger at 9 a.m., for example, or a parent who preorders comforting peanut-butter-and-jelly sandwiches for a hospitalized child appreciates such flexibility. And the hospital welcomes the efficiency and cost savings of the room-service format.

We used to prepare 10 to 12 late trays per meal. Now, none, explains Sandy West, director of food and nutrition services. Our facility opted for a room-service concept because it suits our clients. Boca Raton is a fairly upscale community, so the quality and availability of food is important.

The system required the hospital to install a restaurant-kitchen configuration, with grill station as well as a cold kitchen and deli for appetizers, salads and sandwiches. Since West considers plate presentation important, traditional sectioned trays were replaced by individual place settings.

In addition, the nutrition office was automated and connected to the hospitals data network so food orders can be prepared in accordance with each patients diet. West also added two full-time employees, two part-time cooks and two diet clerks.

STATION BREAKS
Paul Hysen often advises clients to seek a less-costly solution: turning the nurses station on each floor into a mini-kitchen/pantry. When space is available, the area is stocked with shelf-stable food, frozen plated meals, microwave and refrigerator/freezer. Staffers take patient orders, assemble trays and heat and deliver meals. The challenge of the pantry system is controlling inventory. If you dont, you end up feeding the medical staff, says Hysen.

The pantry solution cut late trays from 100 per meal to zero at 1,000-bed Baptist Health Medical Center in Little Rock, Ark. We made the decision to move to pantry service based on our priority to put patients first, says Charlotte Mosqueira, director of food and nutrition services.

Patients like the meal choices and flexibility and speed, she says. Meals come in 10 minutes, not 45 to 60. Each of the 30 nursing stations is equipped with refrigerator and microwave and stocked with basics such as juices and beverages, puddings, gelatins, soups and crackers. And patients can select from a variety of frozen meals or sandwiches. The pantry is inventoried daily and restocked every evening.

BOX TOPS
Becky Ellis eliminates late trays by stretching meal hours at Carilion Health System, a 500-bed hospital in Roanoke, Va., adding a 60- to 90-minute grace period to each meal. The senior director of foodservice includes a continental breakfast served until noon and provides express meals (snack boxes with hot or cold entrées) available after lunch and dinner.

The solution reduces waste. But it is never fail-proof, Ellis points out. What foods go into that box, cold or hot, depend on patients habits. Some patients expect hot food, not a cold snack. Youve got to know their food tastes and cultural considerations.