Food in hospitals : a study of the menus and food service systems in New South Wales hospitals

Abstract

Five separate studies were undertaken in order to assess the menus and food service systems used in Australian hospitals. In the first study, a survey of 270 food service departments in New South Wales (NSW) hospitals was carried out in 1986 using a mailed questionnaire. The results revealed that in almost half of the hospitals the head of department had no formal qualifications. Few hospitals used cook/chill catering systems; 94% used conventional food production with patient meals being plated in a central kitchen location. A significant proportion of hospitals did not satisfy the Australian Council on Hospital Standards recommendations on meal times and in 23% of hospitals the gap between the evening meal and breakfast was 15 hours or longer.

To enable some evaluation of the acceptability of hospital menus, the food preferences of hospital patients were investigated in the second study. A written questionnaire was used to measure the food preferences for 197 different foods of 500 inpatients in a Sydney teaching hospital, using a nine-point hedonic rating scale. The mean preference score of each food was determined as well as the percentage of patients who had never tried each item. The most popular foods were fresh fruits, poultry and red meat. The least popular foods were pulses and offal. The food preferences of Australian inpatients showed significant differences from those found in American studies.

Patient menus in Australian hospitals were assessed in the third study using two methods: (1) a written questionnaire completed by food service managers from 270 NSW hospitals, and (2) an examination of the printed menus collected from 128 of those hospitals. Ninety-six percent of hospitals used a fixed menu cycle (usually 14 days) and 89% allowed patients to select their own menu choices. Most hospitals did not offer more than two hot choices at meals, but larger hospitals provided a wider range of choices than smaller ones. Twenty four percent of hospitals with less than 50 beds used polyunsaturated oil for cooking, while only 7% of larger hospitals did so. Almost all hospitals offered high fibre breakfast cereals and wholemeal bread on their menus and 66% had polyunsaturated margarine as an alternative to butter, but only 25% routinely provided a low-fat milk option. Highly salted foods made up 13% of main menu items and one in five main meal choices could be classified as high in fat. The percentage of unpopular food items included on menus ranged from 12% for soups to 21% for desserts. Ten recommendations to improve the standards of hospital menus and a set of seventeen assessment criteria were suggested.

In the fourth study, thirty hospitals were surveyed to compare the normal cooking methods and warm-holding conditions of vegetables prepared in cook/chill and cook/hot-hold food service systems. Times and temperatures during cooking, holding and service were measured for one day in each hospital. in most hospitals steamers were used to cook potatoes. pumpkin and carrots, but other vegetables were usually boiled. ln hospitals using cook/chill systems, the vegetables were held at high temperatures (above 50°C) for significantly shorter times than in hospitals with cook/hot-hold systems (49 vs 72 min; p<0.001). In cook/chill systems the vegetables underwent longer periods of holding between 10°C and 50°C during cooling and plating (mean 157 min compared with 16 min in cook/hot-hold hospitals; p<0.001). ln 9 of the 11 hospitals using a cook/chill food service temperatures of chilled food rose above the recommended maximum of 10°C before reheating. In four of the hospitals chilled food was not adequately reheated before service to patients. Many of the practices noted in this study could compromise food safety and nutrient retention.

The final experiment was designed to measure the impact of typical food service handling practices in hospitals on vitamin retention. lt examined the losses of vitamin C and 5-methyltetrahydrofolate in seven common vegetables, in simulated cook/hot-hold or cook/chill food services, using infra-red and conduction reheating of bulk or plated food. The results showed that the nutritional quality of vegetables will be better with a conventional catering system than in a cook/chill food service provided warm-holding times in the former are restricted to less than 90 minutes. This study also showed that the different reheating systems appear comparable in their effect on nutrient retention and that folate is highly sensitive to destruction during food service handling. Holding chilled food for up to 2 hours at room temperature did not lead to significant losses of either vitamin C or folate.

The results from these studies indicate that there are many commendable aspects of the menus and food service systems employed in Australian hospitals today. However, more needs to be done to raise the level of qualifications of food service managers, to make meal times and the styles of service more flexible to meet patient needs, to use information on patient food preferences in menu planning, and to ensure that newer cook/chill food service systems do not lead to a nutritionally inferior food supply for patients.