Improving the patient experience one meal at a time

September 27, 2006

(Chicago) - Sometimes innovation in health care takes the form of advanced imaging technology or breakthroughs in drug treatments. Sometimes it takes the form of hamburgers cut into squares and soup served in a cup.

It may seem simple, but these innovations are making a big difference for geriatric psychiatry patients at Rush University Medical Center, which recently established a new meal service to increase patient nutrition and satisfaction.

"We totally changed the way we do business on our geriatric psychiatry unit. It is part of our effort to gear our food and nutrition services to the needs of our patients on the different floors," said Marcy Stone, RD/LDN, assistant director of Food Service Operations at Rush, who led the team that developed the new meal service.

The patients in the geriatric psychiatric unit, located in Rush's Johnson R. Bowman Health Center, range in age from 49 to 101 and suffer from Alzheimer's disease and/or clinical depression. The center that is adjacent to Rush's acute care hospital.provides medical and rehabilitative patient care services to older persons and to persons with short-term and long-term disabilities. These illnesses make it difficult to eat, because the patients become overwhelmed when they see too much food in front of them, and their reduced motor skills make it difficult for them to feed themselves.

"A full tray of food wasn't meeting their needs. Too often patients did not eat and did not want to ask for help," said Kristin Gustashaw, MS, RD, LDN, a clinical dietitian in the department of Food and Nutrition. As a result, patients weren't eating enough to sustain themselves, adding to their health problems.

Modeled after the pediatric menu, the new meal service emphasizes finger foods that patients can handle easily, such as tater tots, chicken nuggets, and fish sticks. Burgers and sandwiches are quartered, fruit is sliced, and soups are served in a cup to make them all easier for the patients to feed themselves. "They can be more independent. They don't need nursing staff to cut up the food for them," said Gustashaw.

Instead of sending full meal trays, food services provides bulk trays of the various foods (a tray each of entrees, soups, fruit, etc.), and the geriatric psychiatry nurses select and serve food from these trays to create meals customized for each patient's specific nutritional needs, preferences, and appetites.

"If they like what they're getting, they certainly will eat more," observed Donna LaFemina, whose mother Rosalina LaFemina is a patient in the unit. "When my mother needs to eat, the nurses know her and know her preferences. They know she's Italian and that she likes pasta, so they give her more pasta. If she finishes a little bowl of something and she's still hungry, they can go back and get more."

Another innovation of the new meal service is a switch from three full meals to five lighter meals a day, beginning with an early continental breakfast, followed by a later breakfast, lunch, dinner, and a heavy night time snack. Spreading out meals allows patients to eat when they're hungry rather than according to a prescribed schedule that may not suit them.

The new meal service also allows for improved charting or documentation of patient food consumption, because serving individual foods rather than a large meal allows nurses to note specifically what the patients ate. The improved charting in turn enables dietitians to assess each patient's food intake and address dietary problems as needed.

Patients are responding very favorably to the new meal service. "It's been a huge success so far," said O'Brien. "The patients are more independent. They are starting to feed themselves because the food is easier to handle, and they're eating more."

Donna LaFemina says the new meal service is part of a larger series of innovations that geriatric psychiatry has implemented to provide excellent patient care. "I see a lot of good things happening on that floor. They're always looking for ways to make things better for the patients. This is a pretty ingenious way to do it."

Rush University Medical Center

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