Say “late trays” to most any foodservice director and more than likely they’ll respond: “They’re a headache, a nightmare, and they always have been.” And that’s precisely what Joyce Hagen-Flint has said, up until this spring.
Hagen-Flint, the director of food and nutrition services at 290-bed Regional Medical Center at Bayonet Point in Hudson, FL, and past president of the American Society for Healthcare Food Service Administrators, was fed up with seeing her department spend a lot of time, energy and money on producing and delivering a growing number of late trays. She was also determined to find a solution.
“It seemed that entering diet changes in the computer—accurately and in a timely fashion—had become less of a priority for nursing,” she explains. “Therefore, patients were receiving the wrong diet and we’d have to resend the tray—and who knows what happened to the original tray.”
‘Just stop’: Without the appropriate labor to undertake room service at this time, but needing to solve the late-tray problem nevertheless, food and nutrition services partnered with nursing and put together a team to brainstorm the topic. “We talked and talked and talked and couldn’t seem to get off the ground until the associate chief nursing officer suggested we just stop serving them,” she recalls.
In their place, the team came up with a sandwich box concept using clear clamshell containers. Options include turkey or roast beef on a soft roll, cheese and crackers, or peanut butter and jelly (PBJ) on melba toast. Each box also includes a pre-packaged, branded fruit cup, graham crackers and appropriate utensils. Hagen-Flint figures that if patient floors are stocked with sandwich boxes, a nurse can walk down the hall, grab the box from the pantry and deliver it to the patient—since the nurses would rather feed the patients themselves than have them go hungry.
And it lets them do so without the hassle of late trays. “We ran a pilot for two weeks,” she points out. “Nursing knew the patients were fed and fed right away. Our staff loved it because they didn’t have to deliver late trays. By the end of two weeks we discovered that the accuracy of the diet orders entered by the cut-off time had improved 85%.”
It’s a date: Nursing leadership was asked to set a date for food and nutrition services to implement the system hospital-wide. Follow-up revealed that accuracy and timeliness improved within one week, Hagen-Flint reports. “April was the pilot and May was the transition during which we added one or two units each week. Looking at the month, the average number of late trays requested dropped to 18 per day and by June it had dropped to six.
Before we began we were seeing an average of 35 late trays per day and on a bad day it could be about 60.”
Overall, the quantity of boxed meals the department needs to send out to each unit per day has decreased from a par level of 36 (including 12 turkey sandwiches, 12 roast beef, six cheese and crackers and six PBJ) to six or eight per floor.
Sandwich boxes are dated with a three-day expiration for freshness, and each bears a sticker indicating its “For a Special Patient.” This label is intended to help nursing keep a close watch over the boxes so that hungry staff members aren’t helping themselves. “It’s their business unit to manage; we transfer the cost of floor stock to the nursing unit so they watch the usage,” she says.
OSU develops late-tray solution
The department of nutrition services at The Ohio State University Hospitals, in Columbus, conducted a quality improvement study and found there was no formal communication regarding the foodservice needs of patients admitted after hours to 200-bed (licensed for 404) University Hospital East division.
In fact, well-meaning staff might call the wrong location, or perhaps no one was in the kitchen at the time of the call. “So we started to track the number of requests and the time it took us to deliver,” notes Mary Angela Miller, administrative director of nutrition services. “When they got the data, they knew they could improve it.
“Now, nursing staff can send an e-mail right to the kitchen or diet office computer. This gives you the time—previously a lot of time was wasted just in tracking. Now, we’re a whole lot more accurate.”
Double time: According to Julie Meddles, RD, LD, associate director, University Hospital East nutrition services was able to reduce the average delivery time of late trays to patients from one hour to 35 minutes by automating the process. “We utilized the medical center’s intranet technology and a Web-based application to create our new UHE-Meal ordering system,” she explains.
At the outset, the late tray work group identified a multitude of problems, Meddles points out.
Problems solved: The new process for creating orders, with assistance from a Web developer, has simplified and resolved problem areas, Meddles asserts. Now:
1. Unit staff creates an order online for patient tray. Only valid diet orders are in system.
2. All information is required before it’s submitted.
3. Unit staff can view orders for entire hospital or sort by unit. No duplicate orders allowed.
4. An order triggers a page beep that is received by nutrition staff. New orders appear in red as “new;” once accepted they become green and show “in progress” and finally turn black when completed. Both unit staff and nutrition staff see the tracking of the trays.
5. Nutrition staff fulfills the order, delivers tray to patient, and indicates when the meal is delivered, allowing tracking of delivery site.
6. The department tracks each tray ordered and online reports. The system tallies all trays by unit and automatically calculates time to complete the order.
“This Web-based application has tremendous potential for other facilities,” Meddles says. “It certainly increased patient satisfaction by giving them ‘what they want when they want it,’” and saved staff resources by eliminating the previous manual process.”