ATLANTA—For the past five years, the trend in hospital foodservice has been moving toward a room service model for patient feeding. Five hundred-bed Piedmont Hospital in Atlanta was one of the hospitals that made the switch from a traditional trayline to room service, which the foodservice department did in 2005. This spring, however, the department abandoned room service when the hospital was forced to find $42 million in savings.
“The organization had to take a hard look at finances and what made sense and what didn’t,” says Mark Galvin, nutrition and food services director. “Room service costs a lot of money, especially in a hospital of this size. It was determined through the strategic cost reduction project that room service just wasn’t sustainable. We were able to [cut] a lot of money out of the budget [by moving away from room service]. Between labor and supply cost reductions, the department shaved over 15% off the operating budget.”
Galvin was able to reduce 17 FTEs by moving away from room service. The department now has 92 FTEs.
New service: Patients are now served using a mixture of room service and a traditional trayline style. Instead of placing orders by calling a call center, foodservice associates take patient orders. This is done in two ways. Foodservice associates either call patients throughout the day to get their orders or associates visit patient rooms to take orders. Galvin says the associates try to get three days of patient orders at one time whenever possible.
Trays are delivered during set times to all patients in a unit. “With room service we were open from 6 in the morning to 11 at night,” Galvin says. “It was like a hotel. Now, we are open from 7 in the morning to 8:30 at night. We bring food to the floor at set times. I’ll use Five South as an example. We’ll batch print all of Five South’s orders and bring that out to the cook’s line and they will cook all that food to order. Then we’ll tray it up. So it’s basically still restaurant-style cooking, but we are delivering it at set times versus having the patients call down when they want to order. The beauty of having set times is you know when your business rush is going to be, and so during the down times the room service reps, or hostesses, are calling patients on the floors or going into rooms and taking the orders with tablets bedside.”
Galvin says the new patient menu is very similar to the old room service menu, with a few changes to streamline the menu. For example, there is only one chicken option whereas the room service menu had four or five. Other items were changed to save cost. Salmon was replaced with crusted tilapia, which saved the department $18,000 annually. Beef tenderloin was replaced by pot roast, which saved the department $50,000 annually.
When a unit’s trays are being assembled, someone from the foodservice department calls that unit’s nursing staff to let them know to expect their patient trays in 10 or 15 minutes. “That’s a win for us because we aren’t waiting for overbed tables to get cleared off,” Galvin says. “It’s a much more efficient process. You no longer have staff waiting around for trays to come up to the floor.”
Advantage, disadvantage: One of the advantages of room service, directors have said, is that they don’t have to worry about delivering a tray to a room when a patient is out for tests or medical appointments. Galvin says the department has a courtesy tray system in case this happens. “Patients who are new admissions or NPO are top priority, and we have a 20-minute or less guarantee to get their trays up.”
For after-hour nutrition needs, the units have nourishment rooms where items like frozen dinners, snacks and sandwiches are stocked. The rooms are locked, but all staff members have the combination to get items for their patients.
Galvin says that fewer than 10 full meals were being ordered between 8 p.m. and 11 p.m. with the room service model. Most orders during those hours were snacks and beverages, which could be accommodated with an enhanced floor stock.
Another room service plus, directors say, is that patient satisfaction increases. However, Galvin says the department’s patient satisfaction increase after the change to room service was “marginal.”
“One of the big drawbacks of room service is the temperature of food because you’re getting orders sporadically and you aren’t going to roll one order out of the kitchen,” Galvin adds. “We would hold carts for 15 minutes and whatever orders would come in that 15 minutes would go up. Well, a tray could sit in the cart for 15 minutes and by the time it travels and gets to the room, you’ve compromised the food temperature a little bit. This way the food is staying in the kitchen hot and being delivered immediately. Our temperature of food scores have gone up a little bit. A lot of things on the menu we can precook and it’s being held on steam tables.”
Galvin says patient satisfaction hasn’t suffered since the move away from room service.
The staff were disappointed with the change at first, Galvin says, but they now see the move as a positive. “At first, naturally, it was a little disheartening because they were really proud. We weren’t the only department having to make major changes. My staff is actually enjoying this method a whole lot more because it’s not as hard on them. They know exactly what time every day we are going to be busy. They can take their breaks at the same time.”