Nutrition Division, Ministry of Health, Jerusalem, Israel.
School of Public Health, University of Haifa, Haifa, Israel.
Isr J Health Policy Res. 2020 Feb 3;9(1):5. doi: 10.1186/s13584-020-0362-0.
A recurring problem in medical institutions is patients not always receiving food meeting their nutritional and medical needs. A proposed contributing factor is non- inclusion of dietitians in food service staff. Recently, positions for food service dietitians in hospitals were created. For the newly defined role of "Food Service Dietitian", comprehensive training courses were developed (70 dietitians participated).
To examine the impact of the addition of the role of a "Food Service Dietitian" in medical institutions on suitability of foods served, food costs and food waste.
A three years (2014-2017) national case study to examine the new role's impact was carried out, in 18 hospitals, nine of which employ a food service dietitian (intervention), and 9 without (control). The number of nutritional analyses of menus was checked, as was the extent of kitchen staff training, and how often night meals were served for all patients. Data were gathered regarding food costs and waste with respect to food distributed to staff and patients. Food costs savings and waste reduction were calculated, based on reduction in provision of unnecessary meals, at a cost of 18 NIS per day per meal.
Kitchen staff training was carried out in all intervention institutions, and not in the controls. In most controls, nutritional analyses were not performed, whereas in the intervention hospitals, full analyses were performed and tailoring of menus to specific department requirements improved significantly. In most intervention hospitals, late night snacks were provided, this not being so in the controls. Total food cost savings of $229,569 per annum was seen in the six intervention hospitals, attributable to 4 factors: 1.Meals not delivered to fasting patients, or those receiving parenteral/enteral nutrition- cost savings of 328,500 NIS ($93,857)2.Better tailoring and monitoring of food delivered to the wards and staff (bread, cheese, milk etc)- annual cost savings of 235,000 NIS ($67,142) in the hospitals with a food service dietitian.3.Checking expiry dates of medical foods, and improved communication between the wards, the kitchen and the food distribution centers, has lessened food waste with savings of 5% from the medical food budget per annum of 40,000 NIS ($11,428).4.As a result of dietitian-performed nutritional analyses, tailoring of food provided according to the patient's medical and nutrition needs was improved. In one hospital, after re-evaluation of serve sizes in high protein diets, sizes were reduced while retaining adequacy, with immediate cost savings of 200,000 NIS ($57,142) per annum.
Implementation of the new role of Food Service Dietitian led to cost savings and significant improvements in adherence to the nutritional care plan.
医疗机构经常存在患者无法获得满足其营养和医疗需求的食物的问题。一个被提出的原因是餐饮服务人员中没有营养师。最近，医院设立了餐饮服务营养师的职位。对于新定义的“餐饮服务营养师”角色，我们开发了综合培训课程（70 名营养师参加了培训）。
检验医疗机构中增加“餐饮服务营养师”这一角色对供应食物的适宜性、食物成本和食物浪费的影响。
我们开展了一项为期三年（2014-2017 年）的全国案例研究，以检验新角色的影响，研究对象为 18 家医院，其中 9 家雇佣了餐饮服务营养师（干预组），9 家没有（对照组）。我们检查了菜单的营养分析数量、厨房工作人员的培训程度以及所有患者夜间用餐的频率。我们还收集了与分发给员工和患者的食物相关的成本和浪费数据。根据减少提供不必要的膳食，计算出了食物成本节约和浪费减少的情况，每天每餐的成本为 18 新谢克尔。
所有干预机构都对厨房工作人员进行了培训，但对照组没有。在大多数对照组中，没有进行营养分析，而在干预医院中，进行了全面的分析，并且根据特定部门的需求定制菜单的能力显著提高。在大多数干预医院中，为患者提供了夜间小吃，而对照组则没有。在六个干预医院中，我们看到了每年 229,569 美元的总食物成本节约，这归因于以下 4 个因素：1. 未向禁食患者或接受肠外/肠内营养的患者提供膳食-节约 328,500 新谢克尔（93,857 美元）；2. 更好地定制和监测分发给病房和工作人员的食物（面包、奶酪、牛奶等）-在有餐饮服务营养师的医院中，每年节约 235,000 新谢克尔（67,142 美元）；3. 检查医用食品的有效期，并改善病房、厨房和食品配送中心之间的沟通，使每年医用食品预算的浪费减少 5%，节约 40,000 新谢克尔（11,428 美元）；4. 由于营养师进行了营养分析，根据患者的医疗和营养需求定制食物的能力得到了提高。在一家医院中，在重新评估高蛋白饮食中的供应份量后，在保持充足供应的同时减少了份量，每年立即节约 200,000 新谢克尔（57,142 美元）。
实施餐饮服务营养师的新角色导致了成本节约，并显著改善了对营养护理计划的遵守情况。
