Servicios Generales

The present article describes the activity performed by the medical support services and, more specifically, by operational services (which include mainly cleaning, laundry, and non-patient transport) and catering. We outline the normal activity of these services and then provide details of how they were affected on 11 March and subsequent days. Data relating to the Rehabilitation Centers and Ophthalmology Institute are not included as they were not significantly affected from the point of view discussed herein.

[Risk management and hospital food service: food safety quality system in healthcare]

In this article we describe a project about reorganisation of dietetic and hospital food service which aims to implement a food safety quality system from the prospective of risk management approach. The main objective is to develop structural and systematic activities from the medical direction point of view on all those activities concerning with hospital food service and dietetic with the following actions: 1) epidemiologic surveillance, 2) monitoring and output control, 3) education, training and information for staff and patients. The operative context is particularly complex for many reasons: the prevalent tendency to outsourcing for food service, the involvement of many professionals and several medical and non medical units. Actually after the redefinition of the main tasks (food hygiene and dietetic are the first functions) the organizational analysis, we have already done the corrective actions finalized to the improvement of quality and it is going to be ready a list of quality indicators to evaluate and continuous monitoring efficacy on the same corrective actions.

Ward nutrition coordinators to improve patient nutrition in hospital

It is important that patients receive adequate nutrition while in hospital. Reports and research over the past 10 years have highlighted the problems in the NHS of managing the nutritional needs of patients (King's Fund, 1992; McWhirter and Pennington, 1994; Edington et al, 2000). This article describes a successful pilot study addressing nutrition at the ward level. It resulted from a multidisciplinary team forming to share their specific nutritional concerns; through creative thinking they devised a new role of nutrition coordinator. In the study a healthcare assistant was used from the existing ward establishment and given one-week intensive multidisciplinary induction before commencing the role in the wards. The main focus of the role was to facilitate, rather than undertake, the nutritional care of patients throughout their stay. Following a 6-month trial, the role demonstrated a significant impact on nutritional screening, nutritional service, patients' perceptions of their nutritional care, and staff satisfaction.

A bedside food cart as an alternate food service for acute and palliative oncological patients

Patients with advanced cancer experience various problems with eating, and their meals should be tailored to meet their specific needs. Two methods of food service were compared in a shared acute oncology/palliative care unit; an electrical food cart allowing patients to select their food types and portions at the bedside, and a traditional food tray delivery service that relied on meals being prepared in a centralized kitchen and then delivered by tray. Over a 10-day period, lunch meals were delivered by food cart and supper meals via food trays. Twenty-seven out of 32 patients participated in the trial. Patients significantly preferred the food cart to the trays with respect to the timing and appeal of the meal, appropriateness of food types and food portions and the variety of the food choices. A food cart as used in this trial provides a more flexible and appropriate method of food delivery to in-patients in the oncology and palliative unit. Further studies should examine whether this translates to improved caloric intake and quality of life parameters.

Food safety of allergic patients in hospitals: implementation of a quality strategy to ensure correct management

Food allergy could affect up to 8% of children. Four cases of food anaphylaxis in hospitalized children are reported, pointing to the need of food allergenic safety procedures in hospital settings. The implementation of the operating procedure in hospital food production units (HFPU) of Nancy University Hospital is described. The dietetics Department developed on hypoallergenic diet and specific avoidance diets. Dieticians within HFPU managed the choice of starting materials, the circuit organization in order to avoid any risk of contamination during preparation and cooking of food, product traceability, and trained the staff of HFPU. Within the care units physicians, dieticians, nurses, hospital workers are involved in meal management. A diet monitoring sheet is integrated into the patient's nursing file and enables the dietician to validate the diet in the computer, the nurses to display the patient's diet on the schedule on the wall in their office. The hospital workers finally use a tray form indicating the patient's identity, his/her diet and the menu of the day. Such a procedure absolutely secures the whole circuit and specifies the responsibilities of each person, whilst ensuring effective cooperation between all partners. Since 1999, the implementation of this multi-step strategy has prevented from any further reaction in a department specialized for food allergies in children and in adults. As setting up food allergenic safety in hospitals in not addressed adequately in the European directives, it's judicious to draw attention of hospital catering managers and hospital canteen staff to this necessity.

Food procurement. Making a meal of it

The NHS needs to explore alternative approaches to food procurement in the interests of good nutrition and waste reduction. Other European countries have interpreted EU regulations on public sector procurement in ways which allow them to buy local produce. Many trusts are unsure about their powers to implement changes in food procurement.

A food services security survey

Following a recent increase in reported theft, embezzlement, and pilferage in the storage and production areas of the hospital's Nutrition & Food Services, department, the protective service department, in cooperation with the NFS director, conducted a survey of overall security systems and staff awareness as well as specific vulnerabilities to theft which required correction.

Hereford Hospital: a 65 m Pounds PFI development project

The new 340-bed acute general hospital at Hereford is one of a growing number of innovative PFI healthcare projects where Sodexho is a leading consortium member. The company is an equity partner with a 30-year contract to provide support services.

[New procedure for the early detection and control of hospital malnutrition]

The serious problem of hospital undernutrition is still being underestimated by medical staff of modern hospitals, despite its impact on clinical evolution and hospitalisation costs. The actual system used to detect undernutrition in hospitals depends on doctor's sensitivity and not even the 10% of the cases that require intervention are detected. The screening methods developed so far are not useful for daily clinical practice due to their low effectiveness/cost ratio. We present a screening method that allows an automatic daily assessment of nutritional status, of all inpatients that undergo routine analysis. The system is based on a computer application that compiles daily all patients' information available in hospital databases, through the internal network. It automatically assesses the nutritional status of patients taking into account laboratory information concerning albumin, total cholesterol and total lymphocyte count. This tool also provides diagnostic and patients data for physicians' usage. The screening method has been validated, obtaining a sensitivity of 92.3 and specificity of 85.0, considering only laboratory information. This is an efficient tool for early detection and permanent control of hospital undernutrition, with the suitable characteristics for these screening functions, such as its sensitivity, specificity, universality, economy and harmlessness, as well as a great versatility for undertaking a high number of studies regarding the hospital undernutrition problem. We trust that working with it we will obtain a remarkable welfare improvement as well as make aware to people in charge of Public Health of the magnitude of the undernutrition's derived consequences of hospital's in-patients, and after discharge.

[Vertical integration and contracting-out in generic hospital services in Spain]

OBJECTIVES

This study examines the factors that influence make or buy decisions corresponding to four generic services (housekeeping, laundry, food services, and maintenance and security) in Spanish hospitals (3,160 transactions in 790 hospitals).

METHODS

The empirical estimation of a logistic model based on hospital utility maximization is presented. Factors included in the model are not only those related to transaction costs, but also those related to public intervention and the political dimension.

RESULTS

A total of 55.7% of hospitals contracted-out at least one of the generic services. The services most frequently contracted-out were housekeeping and maintenance and security(45.1 and 32.5%, respectively). In contrast, the services (94.3% and 80.1%, respectively). Hospital size (economies of scale), measured by the number of beds, was one of the most important factors influencing make or buy decisions.

CONCLUSIONS

We find evidence that economies of scale are related to a higher level of vertical integration, while specialization and for-profit objectives favor the decision to contract-out. The choice of organizational model for laundry services presents a different pattern from that of the other three services. Empirical results show that some asset specificity could be present in laundry services.