Hospital Food: Will evidence and accountability be the end of rethermalized food?

The food served in hospital may be directly linked to chances of survival for critically ill patients according to Dr. Daren Heyland, a staff physician at Kingston General Hospital.

Heyland and his research team has just received a grant from the U.S. National Institute of Health to continue research into meeting the nutrition needs of high risk, critically ill patients. According to release from Queen’s University, such a grant to a Canadian researcher is rare.

“The optimal amount of energy and protein given to a critically ill patient remains unclear but CERU’s (Queen’s University Clinical Evaluation Research Unit) review of current intensive care unit nutrition practice shows over recent years the amount of energy and protein delivered to critically ill patients is too low,” the release states (emphasis added).

There’s no question that every time you process food, it loses much of its nutritional value.

When a hospital converts from fresh to rethermalized food service, the patient meals lose more nutrition in the cooking, freezing, and reheating process. This is a scientific fact.

The proteins that patients need are altered in the process, or what some call “denaturing.” According to one source, “protein molecules are long chains of 100 or more amino acids all linked together forming a coil called an alpha helix. When a protein is stressed, as it is when it is heated or cooked, it begins to uncoil and changes, losing or altering some of its properties.”

Earlier this year OPSEU took advantage of the freedom of information process to seek food costs at South Bruce Grey Health Centre (SBGHC).

SBGHC was symbolic in that its four sites are situated among some of the most productive farm land in the province. The decision to convert from fresh local food to rethermalized meals trucked in from Toronto was a slap in the face to the local community. It was also taking place at a time when the province was trying to get its public sector institutions to access and serve more local food.

Back in 2006-07 when South Bruce Grey Health Centre was only serving fresh food, the cost per patient day was $59.80. SBGHC is a very small rural hospital system that can’t take advantage of the same economies of scale of their urban cousins. Costs per patient day have always been among the highest in the province.

As talk turned to saving money through rethermalization, the cost per day of serving fresh food dramatically escalated to $78.99 within two years (2008-2009) – an unexplained jump of 32 per cent. This was at a time when the number of meals served were dropping significantly. In 2006-07 SBGHC recorded 23,420 patient days. In 2010-2011 it was down to 18,106 patient days.

In September 2010 the Chesley and Durham sites converted to rethermalized food, Durham being notorious for having one of the hospital vice-presidents walk into the facility and take out all the cutlery from the building, leaving physicians to use medical instruments to eat their own lunch.

Walkerton and Kincardine converted to rethermalized food in July 2011.

By 2011-12 the cost per patient day dropped to $67.36* – still well above the hospital costs for fresh food in 2006-07.

Without an explanation of why fresh food costs rose so dramatically between 2007 and 2010, it is hard to assess the true cost differentials, but the numbers would suggest the overall impact on the hospital’s budget would be minimal – much less than one per cent.

And food is not the only cost to rise at SBGHC. Its overall cost per patient day escalated from $1,902 in 2007-08 to $2,570 by 2011-12 – an increase of almost 26 per cent in five years at a time when inpatient days were dropping.

While Dr. Heyland’s research may lead to better nutrition for critically ill patients, it won’t be by improving the quality of meals eaten. The “TOP UP” trial will examine whether “topping up” with intravenous nutrition can improve the survival rates of the critically ill. The research money will allow them to expand the trials beyond Kingston to 2000 patients from 40 intensive care units.

If the trials are successful, will hospitals look at the benefits of better nutrition for other less critical patients? Numerous hospitals have already shed rethermalized food for fresh. Menu-based food service is also proving to be a hit and reducing food waste.

Hospitals may very well be looking at improving food as a way of bringing up their patient satisfaction scores. Now that this information is public and part of the accountability process, paying attention to such issues could make a significant difference.

In the food heartland, will SBGHC revisit the issue?

Those who made the controversial decision to go with rethermalization are largely gone.

The issue has had remarkable staying power in the communities SBGHC serves. Letters to the editor of the local newspapers still talk about the food at the hospital.

A new CEO could make a lot of friends by giving the community what it wants and the evidence suggests.

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