1. Waltick Memorial Hospital -Nutrition Solutions- Dietetic Consultants: Dawn Frick, RD, LDN Samantha Walters, RD, LDN

2. Nutrition Solutions Who are we? Our Goals Our Mission = Waltick Memorial Mission Consulting Tasks

3. Waltick Memorial Hospital 400 bed community hospital Medical/Surgical, GI, Cardiology, Oncology Recently opened outpatient clinics: – Open Monday-Friday (7-3p) Diabetes Eating disorders

4. Nutrition Solution Proposals Patient Meal Delivery System Improved Menus and Menu Cost RD Staffing Resolution Equipment Sustainability

5. Patient Meal Delivery System

6. Meal Delivery System Current problems include: Inaccurate patient meals Poor patient satisfaction Patient complaints Proposed solutions must consider: Budget restrictions Choices available Patient satisfaction

7. Meal Delivery Options Room Service Style At Your Request (AYR) – Needs – Menus, customer service (diet office staff), production staff, tray line, runners Expressly For You (EFY) – Needs – Menus, production staff, tray line, runners, with the addition of a dietitian or diet tech in patient rooms to receive orders

8. Room Service Solution Advantages Patient decides meal Variety of selections available Flexibility with time and selections Financial – Food – Length of stay Disadvantages Decrease in speed and efficiency Time limits Increase in employees – production, runners, diet office

9. Meal Delivery Options Commissary Style Centralized food preparation Distributed to satellite centers Positive feedback from current users Availability in the area – Ten miles away – Meade Hospital

10. Commissary Solution Advantages Fewer employees in food service Lowered food and supply costs Lowered needs for new equipment and maintenance Increased flexibility Disadvantages Some new equipment needed – freezers, warmers Transportation costs Food safety and HACCP regulations Food quality and patient satisfaction

11. Meal Delivery Options Ready-Prepared Foods prepared on site Foods stored in freezers until use 2 weeks to 3 months Foods heated as needed Convection oven, microwave, or infrared oven

12. Ready-Prepared Solution Advantages Flexibility in food preparation and employee schedules Fewer employees – decrease cost Disadvantages New equipment needed New menu items required Many current menu items wont freeze well Food quality Patient satisfaction – new foods and perception

13. Meal Delivery Options Assembly Serve Convenience foods Frozen, refrigerated, room temperature Offer foods that require minimal preparation Café settings

14. Assembly Serve Solution Advantages Less equipment Less employees Disadvantages Limited variety Patient satisfaction Rise in food cost Limited ability to modify diets and snacks

15. Waltick Memorial Solution Room Service Option Patient Oriented – Taste preferences – Willingness to eat Recovery time – Scheduled around medications and procedures Retail Sales Patient Satisfaction Budget Friendly

16. Improved Menus and Menu Cost

17. Diet Specific Menus New diet and menu plans needed AYR service Equipment dependent Budget Menu cycle

18. General Diet – Breakfast Proposal SundayMondayTuesday Breakfast Orange Juice Oatmeal Scrambled Eggs Sausage Apple Spice Muffin Margarine Low Fat Milk Coffee Non-Dairy Creamer Sugar Salt and Pepper Orange Juice Cream of Wheat Scrambled Eggs Pancakes Syrup Margarine Low Fat Milk Coffee Non-Diary Creamer Sugar Salt and Pepper Orange Juice Rice Krispies Scrambled Eggs Bacon Blueberry Muffin Margarine Low Fat Milk Coffee Non-Diary Creamer Sugar Salt and Pepper

19. General Diet – Lunch Proposal SundayMondayTuesday Lunch Iced Tea Chicken Noodle Soup Crackers Hamburger on a bun Lettuce/Tomato/ Onion Cole Slaw Fresh Fruit - Apple Ketchup Mustard Salt and Pepper Iced Tea Grilled Chicken Sandwich Lettuce/Tomato Glazed carrots Fruit Cocktail Mayonnaise Salt Pepper Iced Tea Tomato Soup Crackers Turkey Sandwich Lettuce/Tomato French Fries Fresh Fruit - Banana Mayonnaise Salt and Pepper

20. General Diet – Dinner Proposal SundayMondayTuesday Dinner Grilled Chicken Breast Mashed Potatoes Gravy Green Beans Dinner Roll Margarine Low Fat Milk Coffee Non-Dairy Creamer Sugar Salt Pepper Cream of Mushroom Soup Crackers Roast Beef Gravy Baked Potato Broccoli Chocolate Cake Dinner Roll Margarine Low Fat Milk Coffee Non-Dairy Sugar Salt Pepper Tossed Salad Italian Dressing Spaghetti and Meatballs Green Beans Breadstick Pineapple Margarine Low Fat Milk Coffee Non-Dairy Creamer Sugar Salt and Pepper

21. Reducing Meal Cost Patient satisfaction Budget concerns – Current meal cost $7.50 – New cost limit $5.85

22. New Cost – Breakfast Day One Menu ItemServing SizeCost Orange Juice Oatmeal French Toast Syrup Margarine Low Fat Milk Coffee Non-Dairy Creamer Sugar Salt Pepper 4 fl. oz. 4 oz. ladle 2 slices 1 oz. 1 pat 8 fl. oz. 6 fl. oz. 1 1 packet $0.18 $0.12 $0.20 $0.16 $0.02 $0.23 $0.10 $0.05 $0.00 Total: $1.06

23. New Cost – Lunch Day One Menu ItemServing Size Cost Chicken Noodle Soup Crackers Chicken Salad Sandwich Potato Salad Chocolate Chip Cookies Salt Pepper Iced Tea 4 oz. 1 pkg. #12 scoop/1 slice #12 scoop 2 1 packet 8 fl. oz. $0.48 $0.03 $0.83 $0.05 $0.15 $0.00 $0.01 Total: $1.55

24. New Cost – Dinner Day One Menu ItemServing Size Cost Roast Turkey Gravy Dressing Broccoli Dinner Roll Margarine Low Fat Milk Coffee Non-Dairy Creamer Sugar Salt Pepper 3 oz. 2 oz. ladle #12 scoop 2 spears 1 roll 1 pat 8 fl. oz. 6 fl. oz. 1 1 packet $0.97 $0.04 $0.18 $0.33 $0.12 $0.02 $0.23 $0.10 $0.05 $0.00 Total: $2.04

25. New Meal Cost Summary Day 1Day 2Day 3 Previous Cost $ 7.50 New Cost $4.65$5.12$5.46 Savings $2.85$2.38$2.04

26. Menu Cycle 7 day cycle – Average length of stay – Weekday and weekend Cost effective Patient satisfaction Food service implications

27. Available overnight for in-patient diabetics Contain 15-20g carbohydrates and about 1 serving of protein 7 day fixed snack schedule Average cost per snack: $0.70 HS Snack Rotation

28. DayHS SnackCarbohydrate Count (g) Total Cost per HS Snack Monday 3 graham cracker squares and 8 oz. skim milk 18 g$0.64 Tuesday 1 slice whole wheat bread and 1oz. sliced turkey 15 g$1.03 Wednesday 6 whole grain crackers and and 1oz. low-fat cheese 15 g$0.63 Thursday 2/3c. Nonfat sugar-free yogurt with 3 graham cracker squares 18 g$0.88 Friday Small apple and 1/2 cup low-fat cottage cheese 17 g$0.75 Saturday 6 whole grain crackers and 2 Tbsp. peanut butter 16 g$0.48 Sunday 1 slice whole wheat bread and 1 oz. sliced ham 15 g$0.52

29. RD Staffing Resolution

30. RD Staffing Breakdown The Team – 2 Experienced Full-time RDs – 2 Entry-level Full-time RDs – 1 Entry-level Part-time RD – 1 Full-time Diet Tech – 1 Part-time Diet Tech Part-time employees strictly work outpatient All full-time RDs rotate Saturday shifts

31. Week 1 – Master Cycle Schedule MondayTuesdayWednesdayThursdayFridaySaturday RD1 (7-3) RD2 (8-4) RD3 (8-4) RD4 (8-4) DT1 (9-5) OPD: RD5 (8-12) DT2 (8-12) RD1 (7-3) RD2 (8-4) RD3 (8-4) RD4 (8-4) DT1 (9-5) OPD: RD5 (8-12) DT2 (8-12) RD1 (7-3) RD2 (8-4) RD3 (8-4) RD4 (8-4) DT1 (9-5) OPD: RD5 (8-12) DT2 (8-12) RD1 (7-3) RD2 (8-4) RD3 (8-4) RD4 (8-4) DT1 (9-5) OPD: RD5 (8- 12) DT2 (8-12) RD2 (8-4) RD4 (8-4) RD3 (8-4) DT1 (9-5) OPD: RD5 (8-12) DT2 (8-12) RD1 (8-4) -RDs only available in outpatient from 8-12p Monday-Friday -One RD available, on Saturdays, and none on Sundays

32. Equipment

33. Equipment Purchases $40,000 budget “Wish-list” Improved retail area – Patient satisfaction – Sustainable practices Energy-efficient equipment Removal of disposables – More variety – Retail sales

34. Equipment Purchasing List Major Purchases (at least $2,000 per item) Minor Purchases (< $2,000 per item) Dish Machine Plate Lowerator Refrigerator/Freezer Grill China Plates China Bowls Tablespoons Knives Forks Trays Food Warmer Steam Table Steam Pans Toaster Oven Robot Coupe Coffee Condiment Holder Coffee Maker Coffee Mugs

35. Equipment Purchasing Overview Totals – $29,469.88 in major purchases – $9,939.50 in minor purchases $590.62 leftover 1 year parts and labor warrantee Lifetime edge chip limited warrantee

36. Our Vision Improved retail area – More variety and convenience for customers – Help yourselves – Feel at home – Increased sales Improved quality of food – More equipment – More storage

37. Sustainability

38. Organic and Non-Organic Waste Food waste – The Digester ® – Cooking Oil – “Stop Wasting Food” initiative Eliminate disposable dishes Recycling program

39. Sourcing Local, Seasonal, and Sustainably Grown and Raised Products Environmental impact Less nutrients lost Fishing Farming – Safe farming practices – Supporting local economy

40. Water Intensity Flow restrictions, regulators, and pressure- limiting valves Water taps in food service Energy-saving/water-saving kitchen equipment

41. Questions

42. References http://www.webstaurantstore.com/viewcart.cfmhttp://www.webstaurantstore.com/viewcart.cfm. FoodManagementSystems.com Johns Hopkins Hospital’s Daily Menu Cycles and Specialized Diets St. Joseph Medical Center’s Daily Menu Cycles and Specialized Diets Sodexonet.com https://www.flickr.com/photos/8004703@N05/