Troy & Denise in the kitchen_21.12.16
Pre-plated frozen meal trial at Central Queensland site delivers better outcomes for patients

In a major delivery model innovation for the sunshine state, Queensland Health has been working to provide pre-plated frozen meals to hospitals in remote areas. We spoke to two of the program’s pioneers, dietitian consultant Denise Cruickshank and senior project officer/food safety auditor Troy Litzow.

“The impetus for the program was the need to solve a combination of issues around infrastructure, meeting standards for both food nutrition and safety, and providing patients with choice,” Troy explains.

“The trial we undertook looked at all of those – we replaced our former system with providing a pre-plated meal that had been delivered frozen and then reheated before serving to patients.

“We ensured that the menu was planned in such a way that it met Queensland Health Nutrition Standards for meals and menus 2015, our requirement for having all ingredients and allergens identified, and that it could be prepared with the relatively small amount of equipment available to the hospital.”

Patient surveys and a food waste assessment were undertaken and feedback sought from hospital staff, with results positive in all areas, including the fact that patients gained weight and were therefore receiving better nutrition.

Troy and Denise both work for Queensland Health’s Statewide Food Services Network, hosted by Metro North Hospital & Health Service based at Royal Brisbane and Women’s Hospital, from which services are provided across the state.

“We examine where there can be initiatives undertaken that will provide positive outcomes for patients – where we can deliver increased patient satisfaction,” Troy emphasises.

The trial was undertaken in 2014 for six months, with the pre-plated meal (PPM) model of service delivery retained by the remote area site – a small rural community west of Rockhampton in central Queensland.

Troy explains some of the issues with the former model: “To get fresh produce for the community they need to transport it from a big centre like Emerald or Rockhampton. Then there is the issue of ensuring the food stays fresh on the site – you might have people who don’t want to eat those choices, or perhaps they might buy in more than needed.”

The conventional model in Queensland Health facilities has been to buy food in bulk from an external provider, reheat it on site and deliver it hot on a tray via a trolley to patients. Smaller rural facilities have always cooked food fresh but limiting meal choices can sometimes impact on nutritional standards and patient choice.

“When you order in cartons of PPM, all the meal components – the protein, the white and green and yellow vegies, are already on the plate,” Troy explains.

“This saves the issue of plating it up. Staff are always encouraged to make fresh salads and sandwiches, so fresh vegies are still on offer, but the main dietary components are now delivered as PPMs. They’re continuing with this model and a couple of times a month they also do a fresh-cooked option for more culturally significant meals, like those which mark particular occasions.”

Patients at the site now have access to a much wider range of meal options. “Bringing in the PPM gave patients a choice of 12 to 14 options which can be stored in the freezer until needed, from spaghetti bolognese to chicken chasseur, bangers and mash, rissoles and gravy … it opened up much more patient choice, increasing the likelihood that they would like the meal and therefore eat the meal. So better nutrition for the patient as well as less waste for the site.”

The new service delivery model also enables tighter control on nutritional components of meals, as Denise explains: “When you have a standard, portion controlled item delivered, you know what you’re receiving nutritionally, and with the PPM there’s no variation in serving size. Whereas sites buying in meals in bulk might provide a very small serve because they assume the patient won’t eat much. With the PPM, you have a standard size, so patients can achieve their nutritional requirements by eating what’s on the plate.”

Denise was the dietitian who developed the menu in conjunction with another site-visiting dietitian to ensure the required therapeutic diets were able to be provided, and also analysed the patient satisfaction surveys and waste audits. “I went out to the site prior to starting the trial and observed what they were doing with their cook fresh meals – checked the plate waste after serving and also what was left over in the kitchen, as well as patient satisfaction.”

She and the other dietitian then went back about 6-8 weeks after the trial started and repeated the same checks. “We compared before and after, tracking the patients’ weights and their need to have additional nutritional supplements to make up for any shortfall in their diet. When we looked at the pre- and post-data we saw some very positive outcomes.”

The meals themselves were sourced from suppliers which currently provide PPMs to other hospital food services across Australia. The supplier delivered samples and all meals were evaluated for taste and the “homestyle feel” prior to being used on site. “The actual site picked the meals they thought their clients would like,” Troy explains. “If the project was to be expanded, there would be an official tender process, and of course all those meals need to go through a formal evaluation via the procurement arm of Queensland Health.”

Both Troy and Denise are hopeful that the program’s success will lead to its implementation at more sites. “We’ve recently published an abstract in our internal clinical publication, and Troy and I have both presented at national conferences,” Denise says.

“It’s a matter of getting the word out – it is a big change for other places to get their heads around, and you have to go through the process thoroughly. Rural sites tend to have longterm dedicated staff and you cannot expect wholesale change. We need to work together to achieve change through consultation and review.

“We would only ever suggest that people trial it,” Troy adds. “There are plenty of positives that can be gained, but you need to do it right – there are a lot of infrastructure and logistics requirements involved, and we’re here to provide support. But the invitation is out there and the seed has been sown.”