Waltick Memorial Hospital Nutrition Solutions Dietetic Consultants Dawn

Waltick Memorial Hospital -Nutrition Solutions. Dietetic Consultants: Dawn Frick, RD, LDN Samantha Walters, RD, LDN

Nutrition Solutions l l Who are we? Our Goals Our Mission = Waltick Memorial Mission Consulting Tasks

Waltick Memorial Hospital l 400 bed community hospital Medical/Surgical, GI, Cardiology, Oncology Recently opened outpatient clinics: – Open Monday-Friday (7 -3 p) l l Diabetes Eating disorders

Nutrition Solution Proposals l l l Patient Meal Delivery System Improved Menus and Menu Cost RD Staffing Resolution Equipment Sustainability

Patient Meal Delivery System

Meal Delivery System l Current problems include: l l Inaccurate patient meals Poor patient satisfaction Patient complaints Proposed solutions must consider: l l l Budget restrictions Choices available Patient satisfaction

Meal Delivery Options l Room Service Style l At Your Request (AYR) – l Needs – Menus, customer service (diet office staff), production staff, tray line, runners Expressly For You (EFY) – Needs – Menus, production staff, tray line, runners, with the addition of a dietitian or diet tech in patient rooms to receive orders

Room Service Solution l Advantages l l Patient decides meal Variety of selections available Flexibility with time and selections Financial Food – Length of stay – l Disadvantages l l l Decrease in speed and efficiency Time limits Increase in employees – production, runners, diet office

Meal Delivery Options l Commissary Style l Centralized food preparation l Distributed to satellite centers l Positive feedback from current users l Availability in the area – Ten miles away – Meade Hospital

Commissary Solution l Advantages l l l Fewer employees in food service Lowered food and supply costs Lowered needs for new equipment and maintenance Increased flexibility Disadvantages l l Some new equipment needed – freezers, warmers Transportation costs Food safety and HACCP regulations Food quality and patient satisfaction

Meal Delivery Options l Ready-Prepared l l Foods prepared on site Foods stored in freezers until use l l 2 weeks to 3 months Foods heated as needed l Convection oven, microwave, or infrared oven

Ready-Prepared Solution l Advantages l l l Flexibility in food preparation and employee schedules Fewer employees – decrease cost Disadvantages l l New equipment needed New menu items required l l l Many current menu items wont freeze well Food quality Patient satisfaction – new foods and perception

Meal Delivery Options l Assembly Serve l Convenience foods l l l Frozen, refrigerated, room temperature Offer foods that require minimal preparation Café settings

Assembly Serve Solution l Advantages l l l Less equipment Less employees Disadvantages l l Limited variety Patient satisfaction Rise in food cost Limited ability to modify diets and snacks

Waltick Memorial Solution l Room Service Option l Patient Oriented Taste preferences – Willingness to eat l Recovery time – Scheduled around medications and procedures – l l l Retail Sales Patient Satisfaction Budget Friendly

Improved Menus and Menu Cost

Diet Specific Menus l l l New diet and menu plans needed AYR service Equipment dependent Budget Menu cycle

General Diet – Breakfast Proposal Breakfast Sunday Monday Tuesday Orange Juice Oatmeal Scrambled Eggs Sausage Apple Spice Muffin Margarine Low Fat Milk Coffee Non-Dairy Creamer Sugar Salt and Pepper Orange Juice Cream of Wheat Scrambled Eggs Pancakes Syrup Margarine Low Fat Milk Coffee Non-Diary Creamer Sugar Salt and Pepper Orange Juice Rice Krispies Scrambled Eggs Bacon Blueberry Muffin Margarine Low Fat Milk Coffee Non-Diary Creamer Sugar Salt and Pepper

General Diet – Lunch Proposal Lunch Sunday Monday Tuesday Iced Tea Chicken Noodle Soup Crackers Hamburger on a bun Lettuce/Tomato/ Onion Cole Slaw Fresh Fruit - Apple Ketchup Mustard Salt and Pepper Iced Tea Grilled Chicken Sandwich Lettuce/Tomato Glazed carrots Fruit Cocktail Mayonnaise Salt Pepper Iced Tea Tomato Soup Crackers Turkey Sandwich Lettuce/Tomato French Fries Fresh Fruit Banana Mayonnaise Salt and Pepper

General Diet – Dinner Proposal Dinner Sunday Monday Tuesday Grilled Chicken Breast Mashed Potatoes Gravy Green Beans Dinner Roll Margarine Low Fat Milk Coffee Non-Dairy Creamer Sugar Salt Pepper Cream of Mushroom Soup Crackers Roast Beef Gravy Baked Potato Broccoli Chocolate Cake Dinner Roll Margarine Low Fat Milk Coffee Non-Dairy Sugar Salt Pepper Tossed Salad Italian Dressing Spaghetti and Meatballs Green Beans Breadstick Pineapple Margarine Low Fat Milk Coffee Non-Dairy Creamer Sugar Salt and Pepper

Reducing Meal Cost l l Patient satisfaction Budget concerns – Current meal cost l – $7. 50 New cost limit l $5. 85

New Cost – Breakfast Day One Menu Item Orange Juice Oatmeal French Toast Syrup Margarine Low Fat Milk Coffee Non-Dairy Creamer Sugar Salt Pepper Serving Size Cost 4 fl. oz. 4 oz. ladle 2 slices 1 oz. 1 pat 8 fl. oz. 6 fl. oz. 1 1 packet $0. 18 $0. 12 $0. 20 $0. 16 $0. 02 $0. 23 $0. 10 $0. 05 $0. 00 Total: $1. 06

New Cost – Lunch Day One Menu Item Serving Size Cost Chicken Noodle Soup Crackers Chicken Salad Sandwich Potato Salad Chocolate Chip Cookies Salt Pepper Iced Tea 4 oz. 1 pkg. #12 scoop/1 slice #12 scoop 2 1 packet 8 fl. oz. $0. 48 $0. 03 $0. 83 $0. 05 $0. 15 $0. 00 $0. 01 Total: $1. 55

New Cost – Dinner Day One Menu Item Roast Turkey Gravy Dressing Broccoli Dinner Roll Margarine Low Fat Milk Coffee Non-Dairy Creamer Sugar Salt Pepper Serving Size 3 oz. 2 oz. ladle #12 scoop 2 spears 1 roll 1 pat 8 fl. oz. 6 fl. oz. 1 1 packet Total: $2. 04 Cost $0. 97 $0. 04 $0. 18 $0. 33 $0. 12 $0. 02 $0. 23 $0. 10 $0. 05 $0. 00

New Meal Cost Summary Day 1 Day 2 Day 3 Previous Cost $ 7. 50 $7. 50 New Cost $4. 65 $5. 12 $5. 46 Savings $2. 85 $2. 38 $2. 04

Menu Cycle l 7 day cycle – – l l l Average length of stay Weekday and weekend Cost effective Patient satisfaction Food service implications

HS Snack Rotation l l Available overnight for in-patient diabetics Contain 15 -20 g carbohydrates and about 1 serving of protein 7 day fixed snack schedule Average cost per snack: $0. 70

HS Snack Rotation Day HS Snack Carbohydrate Count (g) Total Cost per HS Snack Monday 3 graham cracker squares and 8 oz. skim milk 18 g $0. 64 Tuesday 1 slice whole wheat bread and 1 oz. sliced turkey 15 g $1. 03 Wednesday 6 whole grain crackers and 1 oz. low-fat cheese 15 g $0. 63 Thursday 2/3 c. Nonfat sugar-free yogurt with 3 graham cracker squares 18 g $0. 88 Friday Small apple and 1/2 cup low-fat cottage cheese 17 g $0. 75 Saturday 6 whole grain crackers and 2 Tbsp. peanut butter 16 g $0. 48 Sunday 1 slice whole wheat bread and 1 oz. sliced ham 15 g $0. 52

RD Staffing Resolution

RD Staffing Breakdown l The Team – – – l l 2 Experienced Full-time RDs 2 Entry-level Full-time RDs 1 Entry-level Part-time RD 1 Full-time Diet Tech 1 Part-time Diet Tech Part-time employees strictly work outpatient All full-time RDs rotate Saturday shifts

Week 1 – Master Cycle Schedule Monday Tuesday RD 1 (7 -3) RD 2 (8 -4) RD 3 (8 -4) RD 4 (8 -4) DT 1 (9 -5) OPD: RD 5 (8 -12) DT 2 (8 -12) Wednesday Thursday RD 1 (7 -3) RD 2 (8 -4) RD 3 (8 -4) RD 4 (8 -4) DT 1 (9 -5) OPD: RD 5 (8 -12) DT 2 (8 -12) RD 1 (7 -3) RD 2 (8 -4) RD 3 (8 -4) RD 4 (8 -4) DT 1 (9 -5) OPD: RD 5 (812) DT 2 (8 -12) Friday RD 2 (8 -4) RD 4 (8 -4) RD 3 (8 -4) DT 1 (9 -5) Saturday RD 1 (8 -4) OPD: RD 5 (8 -12) DT 2 (8 -12) -RDs only available in outpatient from 8 -12 p Monday-Friday -One RD available, on Saturdays, and none on Sundays

Equipment

Equipment Purchases l l l $40, 000 budget “Wish-list” Improved retail area – – Patient satisfaction Sustainable practices l l – – Energy-efficient equipment Removal of disposables More variety Retail sales

Equipment Purchasing List Major Purchases (at least $2, 000 per item) Dish Machine Plate Lowerator Refrigerator/Freezer Grill Minor Purchases (< $2, 000 per item) China Plates China Bowls Tablespoons Knives Forks Trays Food Warmer Steam Table Steam Pans Toaster Oven Robot Coupe Coffee Condiment Holder Coffee Maker Coffee Mugs

Equipment Purchasing Overview l Totals – – l l l $29, 469. 88 in major purchases $9, 939. 50 in minor purchases $590. 62 leftover 1 year parts and labor warrantee Lifetime edge chip limited warrantee

Our Vision l Improved retail area – – l More variety and convenience for customers Help yourselves Feel at home Increased sales Improved quality of food – – More equipment More storage

Sustainability

Organic and Non-Organic Waste l Food waste – – – l l The Digester ® Cooking Oil “Stop Wasting Food” initiative Eliminate disposable dishes Recycling program

Sourcing Local, Seasonal, and Sustainably Grown and Raised Products l l Environmental impact Less nutrients lost Fishing Farming – – Safe farming practices Supporting local economy

Water Intensity l l l Flow restrictions, regulators, and pressurelimiting valves Water taps in food service Energy-saving/water-saving kitchen equipment

Questions

References http: //www. webstaurantstore. com/viewcart. cfm. Food. Management. Systems. com Johns Hopkins Hospital’s Daily Menu Cycles and Specialized Diets St. Joseph Medical Center’s Daily Menu Cycles and Specialized Diets Sodexonet. com https: //www. flickr. com/photos/8004703@N 05/