Spoken menus, palm-top computers please patients, nutrition staff

Restaurant-style food descriptions tend to perk up patients’ appetites

A hospital’s food, as well as its food service, usually ranks low on the patient satisfaction list. Not only do sick patients often have poor appetites that are altered by medication and pain, they also have a perception of an institutional diet as being unpalatable.

At least 58 facilities are changing that image using a combination of a spoken menu system and palm-top technology manufactured by Bedside Menu Entry by CBORD in Ithaca, NY.

"Patient satisfaction for overall diet and meals has increased from 40% to 87% in the past 12 months," says Patrick Fritz, RD, LD, patient service manager at Ingalls Memorial Hospital in Harvey, IL. The 582-bed facility contracts with Service Master in Downers Grove, IL, to provide patient meals.

Fritz explains today’s push for quicker discharge makes the old way of passing, collecting, and tallying menus obsolete.

Ed Fraine, account operations manager at Jordan Hospital in Plymouth, MA, estimates the palm-held technology eliminated about 85% of diet office paperwork.

The CBORD system, which costs about $5,000 to $10,000 depending upon implementation, features an 11-ounce pocket computer with a miniature screen that folds down on a keyboard. Menu items, based on a patient’s dietary requirements, are uploaded from the diet office and appear on the palm-top screen. Then, at the patient’s bedside, diet office employees take the order and key it into the computer. Finally, the information is downloaded into the diet office’s mainframe computer and generates the menu for the tray line.

At Ingalls Memorial, four patient nutrition representatives visit anywhere from 65 to 120 patients twice a day — before lunch and dinner — to help patients make selections for the upcoming meal. Breakfast selections are made at the time the dinner order is taken.

"In a conventional system," explains Fritz, "patients must decide what they want a day in advance. But, by the time the food actually comes, their mood or their mind may have changed. Or, they’ve been discharged, or transferred to another floor or their diet orders have changed."

With a paper menu system, the lag time between collecting menu and assembling trays can be as much as 20 to 34 hours, which greatly contributes to the bane of a food service department existence: late trays and food waste. Fritz explains that conventional delivery mechanisms just aren’t designed to accommodate patient admissions or transfers.

Most importantly, he points out, food service has been relegated to a faceless entity. "When there is no human contact, no familiar face, patient satisfaction will be compromised," he says. "Not only does the spoken menu and palm-top technology provide an opportunity for interaction, its also helps ensure that the patients get the food they want when they want it."

The Bedside Entry system also cuts food waste to almost nil, Fritz adds. "Because it generates very comprehensive tallies of what we need on the tray line, we can manage purchase and preparation down to the minutia."

The system underscores the priority that Ingalls Memorial puts on patient satisfaction, Fritz says.

"When an articulate and well-dressed employee arrives to say, Good afternoon. I’m here to assist you in making menu choices,’ patients are surprised and pleased," he points out. "Then, when they see it is done with palm-top technology, they are dazzled."

Fritz stresses that the technology, while certainly impressive, is merely a means to an end.

"It’s our people that satisfy patients; the technology simply refines the process," he stresses.

In fact, the spoken menu was put in place before the Bedside Entry System was introduced at Ingalls.

Fritz calls the patient nutrition representatives "on-stage performers," explaining they are diet office employees who are articulate, well-groomed, and enjoy interacting with others.

"They took great care in selecting a uniform in order to develop an appropriate professional image," says Katie Freese, RD, LD, director of food and nutrition.

For example, each speaker wears white pants and white shirts with a colorful jacket embroidered with his or her name.

Only appropriate menu items appear

Using the palm-top technology reduces nutrition training, Fritz adds. All menu items are reviewed so that only appropriate ones appear on the palm-held computer for the patient representative to offer," he says.

This pre-screening method also does not set patients up for disappointment.

"It’s not a matter of asking a renal patient what he wants and then having to apologize because we can’t give him a banana," he says. Instead, the speaker suggests a primary entree and a primary vegetable based on each patient’s diet orders.

"If that doesn’t appeal to the patient, the speaker can hit a toggle key and go to the secondary entrees and vegetables," Fritz says. In special cases, the speaker can write in an item.

While all the menu items were designed to appeal to Midwesterners, they also are lower in fat, sodium, cholesterol, and calories than their typical restaurant counterparts, says Freese.

Favorite menu items tend to be "comfort foods" such as roast beef, chicken pot pie, and macaroni and cheese, she says. "We also offer a homemade soup every day," she adds.

Although the spoken menu and palm-top system have been in use for two years at Ingalls Memorial, Freese and her team continue to look for ways to increase patient perception and satisfaction.

Currently, they are training menu speakers to deliver descriptions of items similar to those of a restaurant menu.

"We encourage them to use words that [can] make an ill person’s appetite perk up — phrases such as cream sauce over a fluffy bed of rice,’ or roast beef with home-style gravy," Fritz explains.


• Katie Freese, RD, LD, Director of Food and Nutrition, and Patrick Fritz, RD, LD, Patient Service Manager, Ingalls Memorial Hospital, One Ingalls Drive, Harvey, IL 60426. Telephone: (708) 915-5700.

• CBORD, 61 Brown Road, Ithaca, NY 14850. Telephone: (607) 251-2410.