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      Assessment of foodservice quality and identification of improvement strategies using hospital foodservice quality model

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          Abstract

          The purposes of this study were to assess hospital foodservice quality and to identify causes of quality problems and improvement strategies. Based on the review of literature, hospital foodservice quality was defined and the Hospital Foodservice Quality model was presented. The study was conducted in two steps. In Step 1, nutritional standards specified on diet manuals and nutrients of planned menus, served meals, and consumed meals for regular, diabetic, and low-sodium diets were assessed in three general hospitals. Quality problems were found in all three hospitals since patients consumed less than their nutritional requirements. Considering the effects of four gaps in the Hospital Foodservice Quality model, Gaps 3 and 4 were selected as critical control points (CCPs) for hospital foodservice quality management. In Step 2, the causes of the gaps and improvement strategies at CCPs were labeled as "quality hazards" and "corrective actions", respectively and were identified using a case study. At Gap 3, inaccurate forecasting and a lack of control during production were identified as quality hazards and corrective actions proposed were establishing an accurate forecasting system, improving standardized recipes, emphasizing the use of standardized recipes, and conducting employee training. At Gap 4, quality hazards were menus of low preferences, inconsistency of menu quality, a lack of menu variety, improper food temperatures, and patients' lack of understanding of their nutritional requirements. To reduce Gap 4, the dietary departments should conduct patient surveys on menu preferences on a regular basis, develop new menus, especially for therapeutic diets, maintain food temperatures during distribution, provide more choices, conduct meal rounds, and provide nutrition education and counseling. The Hospital Foodservice Quality Model was a useful tool for identifying causes of the foodservice quality problems and improvement strategies from a holistic point of view.

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          Most cited references48

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          Food intake in 1707 hospitalised patients: a prospective comprehensive hospital survey.

          This study aimed to assess the ability of the hospital meal service to meet patients' nutritional needs. All hospitalised patients who received 3 meals/day without artificial nutritional support were included. The nutritional values of food served, consumed and wasted during a 24 h period were compared to patients' needs estimated as energy: 110% Harris-Benedict formula; protein: 1.2 or 1.0 g/kg bodyweight/day for patients 65 years old, respectively. A structured interview recorded patients' evaluation of the meal quality, their reasons for non-consumption of food and the relationship between food intake and disease. Out of 1707 patients included, 1416 were fully assessable (59% women; 68+/-21 years; body mass index: 24.3+/-5.1 kg/m(2)). Daily meals provided 2007+/-479 kcal and 78+/-21 g of protein and exceeded patients' needs by 41% and 15%, respectively. However, 975 patients did not eat enough. Plate waste was 471+/-372 kcal and 21+/-17 g of protein/day/patient. Moreover, the food intake of 572 (59%) of these underfed patients was not predominantly affected by disease. Logistic regression analyses identified as other risk factors: elevated BMI, male gender, modified diet prescription, length of stay or = 90 days and inadequate supper. Despite sufficient food provision, most of the hospitalised patients did not cover their estimated needs. Since insufficient food intake was often attributed to causes other than disease, there should be potential to improve the hospital meal service. Copyright 2003 Elsevier Science Ltd.
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            Malnutrition in subacute care.

            Dramatic weight loss and hypoalbuminemia often follow acute hospitalization. The objective was to examine the prevalence of undernutrition in a subacute-care facility. We evaluated 837 patients consecutively admitted over 14 mo to a 100-bed subacute-care center. Nutritional status was assessed by anthropometric measurements, biochemical markers, and a Mini Nutritional Assessment (MNA) score. Primary outcome measures included length of stay and death. Secondary measures included readmission to an acute-care hospital and placement at discharge. The subjects' mean (+/- SD) age was 76 +/- 13 y and 61% were women. Eighteen percent of the subjects had a body mass index (in kg/m(2)) 91% of subjects admitted to subacute care were either malnourished or at risk of malnutrition. The Geriatric Depression Score was higher in malnourished subjects than in nutritionally at-risk subjects (P = 0.05). Length of stay differed by 11 d between the malnourished group and the nutritionally at-risk group (P = 0.007). In the MNA-assessed group of largely malnourished subjects, 25% of subjects required readmission to an acute-care hospital compared with 11% of the well-nourished group (P = 0.06). Mortality was not found to be related to BMI. Malnutrition reaches epidemic proportions in patients admitted to subacute-care facilities. Whether this reflects nutritional neglect in acute-care hospitals or is the result of profound illness is unclear. Nevertheless, strict attention to nutritional status is mandatory in subacute-care settings.
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              The prevalence of undiagnosed protein-calorie undernutrition in a population of hospitalized elderly patients.

              To determine the extent to which patients with objective signs of malnutrition had been diagnosed as such by physicians and the diagnosis documented in the medical record. Cross-sectional. All non-critically ill patients (n = 121) aged 70 years or older admitted to an Oslo hospital during a 3-week period. Compared problem list and other elements of the medical record with observations of height, weight, triceps skinfold, midarm circumference, and arm-muscle circumference made on first weekday in hospital. Serum albumin available on 66 subjects. Nine patients had weight/height ratios below 60% of normal, 16 patients between 60% and 75%, and 41 patients between 74% and 90% of normal. Of these 66 patients, only 24 were recognized as malnourished on admission, only five received nutritional support, and none was diagnosed as having malnutrition at the time of discharge. Malnutrition is underdiagnosed and undertreated. The consequences of this are likely to be deleterious to health.
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                Author and article information

                Journal
                Nutr Res Pract
                NRP
                Nutrition Research and Practice
                The Korean Nutrition Society and the Korean Society of Community Nutrition
                1976-1457
                2005-6168
                April 2010
                29 April 2010
                : 4
                : 2
                : 163-172
                Affiliations
                [1 ]Department of Food and Nutrition, Seoul Women's University, 623 Hwarangro, Nowon-gu, Seoul 139-774, Korea.
                [2 ]Nutrition Team, Korea University, Guro Hospital, Seoul 152-703, Korea.
                Author notes
                Corresponding Author: Kyung-Eun Lee, Tel. 82-2-970-5648, Fax. 82-2-976-4049, klee@ 123456swu.ac.kr
                Article
                10.4162/nrp.2010.4.2.163
                2867228
                20461206
                e79938a4-4dac-4e16-a162-8d2b939bfba2
                ©2010 The Korean Nutrition Society and the Korean Society of Community Nutrition

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 February 2010
                : 30 March 2010
                : 30 March 2010
                Categories
                Original Research

                Nutrition & Dietetics
                hospital,quality model,foodservice,quality hazards,critical control point
                Nutrition & Dietetics
                hospital, quality model, foodservice, quality hazards, critical control point

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