Quality Ratings of a Hospital Foodservice Department by Inpatients and Postdischarge Patients

Objectives To examine quality of food and nutrition services using the ratings of inpatients and patients who had been discharged (postdischarge patients).Design Questionnaires were used to collect perceptions of inpatients and postdischarge patients on the quality of food and nutrition services. A 5-point scale allowed subjects to rate quality from very poor to very good.Subjects Questionnaires were completed by 252 inpatients and 437 postdischarge patients of a midwestern teaching hospital.Statistical analysis Analysis of variance was used to assess differences in quality ratings on the basis of demographic variables. Stepwise regression was used to determine variables that best predicted overall satisfaction. Paired t tests were conducted to compare matched inpatient and postdischarge ratings.Results Ratings of food and nutrition services indicated that patients were satisfied; few differences were found in ratings on the basis of patient demographics. Food quality was the best predictor of overall satisfaction for both inpatients and postdischarge patients. As patient expectations were increasingly met or exceeded, patient ratings of quality increased. The majority of patients in the matched sample gave the same ratings on the inpatient and postdischarge questionnaires.Applications Foodservice managers who desire to improve patient satisfaction should focus attention on meeting or exceeding patient expectations for food quality. J Am Diet Assoc. 1998;98:1303–1307.     

‘How Do You Remember You Ate…?’: A Delphi Technique Study to Identify Retrieval Categories From Fourth-Grade Children

Objective To develop and validate a consensus set of retrieval categories for how children remember what they have eaten, and to relate retrieval categories to accuracy of reporting items eaten during school lunch.Design A Delphi technique study was conducted using 10 psychologists. The subject matter consisted of responses transcribed from interviews conducted with 89 randomly selected fourth graders within 90 minutes of eating. Retrieval categories were evaluated for accuracy by comparing students’ self-reported lunch intake with observation.Statistical analyses For round 1, a centroid hierarchical cluster analysis was used to identify common sets of rating pairs to propose categories for reaching consensus. For rounds 2 and 3, percent of agreement was calculated. Accuracy was tabulated across meal items and student use by retrieval category.Results After round 3, we found that 23 “near-consensus”categories were used by at least eight raters. Six categories were used 60% of the time, 4 were used 20% of the time, and 5 were used 15% of the time. Less frequently used categories were combined with similar, more frequently used categories for a total of 16 categories. Students used a large variety of retrieval categories when accurately reporting consumption. Of the 16 categories, 12 were used similarly by both accurate and inaccurate students. Where there were differences in accuracy by retrieval category, the more accurate students used “taste/smell/texture”and “visual”in deference to “order items consumed”and “oral cue still present.”Applications These categories provide insight into the broad range of retrieval categories that children use and provide direction for researchers to design and study specific cues to enhance the accuracy of children's self-reports of diet. J Am Diet Assoc. 1997;97:31–36.     

Clinical Outcomes in Critically Ill Patients Associated With the Use of Complex vs Weight‐Only Predictive Energy Equations

Background: The energy intake goal is important to achieving energy intake in critically ill patients, yet clinical outcomes associated with energy goals have not been reported. Methods: This secondary analysis used the Improving Nutrition Practices in the Critically III International Nutrition Surveys database from 2007–2009 to evaluate whether mortality or time to discharge alive is related to use of complex energy prediction equations vs weight only. The sample size was 5672 patients in the intensive care unit (ICU) ≥4 days and a subset of 3356 in the ICU ≥12 days. Mortality and time to discharge alive were compared between groups by regression, controlling for age, sex, admission type, Acute Physiology and Chronic Health Evaluation II score, ICU geographic region, actual energy intake, and obesity. Results: There was no difference in mortality between the use of complex and weight‐only equations (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.86–1.15), but obesity (OR, 0.83; 95% CI, 0.71–0.96) and higher energy intake (OR, 0.65; 95% CI, 0.56–0.76) had lower odds of mortality. Time to discharge alive was shorter in patients fed using weight‐only equations (hazard ratio [HR], 1.11; 95% CI, 1.01–1.23) in patients staying ≥4 days and with greater energy intake (HR, 1.19; 95% CI, 1.06–1.34) in patients in the ICU ≥12 days. Conclusion: These data suggest that higher energy intake is important to survival and time to discharge alive. However, the analysis was limited by actual energy intake <70% of goal. Delivery of full goal intake will be needed to determine the relationship between the method of determining energy goal and clinical outcomes.     

A.S.P.E.N. Clinical Guidelines

Background: Children with severe intestinal failure and prolonged dependence on parenteral nutrition are susceptible to the development of parenteral nutrition–associated liver disease (PNALD). The purpose of this clinical guideline is to develop recommendations for the care of children with PN‐dependent intestinal failure that have the potential to prevent PNALD or improve its treatment. Method: A systematic review of the best available evidence to answer a series of questions regarding clinical management of children with intestinal failure receiving parenteral or enteral nutrition was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group. A consensus process was used to develop the clinical guideline recommendations prior to external and internal review and approval by the American Society for Parenteral and Enteral Nutrition Board of Directors. Questions: (1) Is ethanol lock effective in preventing bloodstream infection and catheter removal in children at risk of PNALD? (2) What fat emulsion strategies can be used in pediatric patients with intestinal failure to reduce the risk of or treat PNALD? (3) Can enteral ursodeoxycholic acid improve the treatment of PNALD in pediatric patients with intestinal failure? (4) Are PNALD outcomes improved when patients are managed by a multidisciplinary intestinal rehabilitation team?     

American Society for Parenteral and Enteral Nutrition and American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalist, Specialty, and Advanced) in Nutrition Support

The Standards of Practice for Registered Dietitians in Nutrition Support and the Standards of Professional Performance for the Registered Dietitian in Nutrition Support are key resources for RDs at all knowledge and performance levels. These standards can and should be used by RDs in daily practice to consistently improve and appropriately demonstrate competency and value as providers of safe and effective nutrition support therapy. The standards development and evaluation process is dynamic—these standards will be reviewed at least every 5 years for applicability to practice. Current and future initiatives of A.S.P.E.N. and ADA will provide information that will be used in these updates and in further clarifying and documenting the specific roles and responsibilities of practitioners at each level. As a quality initiative of A.S.P.E.N., its Dietetics Practice Section, ADA, and their DNS DPG, the standards themselves are an application of continuous quality improvement concepts and represent another very important collaborative endeavor.