At Your Request sates patient appetites

By Tamarah Feder

Sometimes, it’s the little things that make a pleasant difference during a patient’s hospital stay. And often, those seemingly insignificant things actually require a great deal of research, organization, and the staff to make it come together seamlessly. The ability to choose a meal that appeals to one’s mood, appetite, and most of all, palette, is just such a thing.

Elizabeth King, a patient at the Montreal General Hospital (MGH) is an enthusiastic fan of the At Your Request room service approach. Launched in 2005, the program provides printed menus to most MGH patients with a broad selection of foods. Patients make their selection and call in their order to a technician who verifies the order against the specific therapeutic needs or dietary limitations of the patient. If there are adjustments to be made, the technician will let the patient know and suggest other options. Within an hour, the patient receives their order, which has been freshly prepared and to their expectations by MGH staff.

“You’re not stuck with what someone else expects you to eat,” said King, as her index finger scrolled across the panels of the menu. “There is so much to choose from. Look! You can have waffles or French toast for breakfast, and fish or hamburger for dinner. Or, if you prefer, a fresh salad and soup, and a treat for dessert,” she said with genuine excitement.

Over the years, King has been required to spend several spells at the hospital and can attest to the benefits and quality of these changes. During her earlier stays, King’s husband would bring his wife home-made food that she preferred. “Before, you could only indicate what you wanted to eat a couple of days before, but you can’t always know what you will be in the mood to eat, or even the level of your appetite by the time the meal would come around. Now, I can order based on what I’m interested in eating within the hour.”

“At Your Request allows patients to feel as though they are contributing to their own well-being by being able to exercise some control over their food,” said Janis Morelli, Manager of Clinical Nutrition Services. Having grown up in the countryside where she enjoyed fresh fruits and vegetables and lots of home cooking, King has always felt the quality of ingredients can add to vitality and happiness. The former ballet dancer, devoted Montessori teacher and world traveller is also a fan of variety, and appreciates the thought put into how the range of dishes reflects the multicultural patient population, “There are different Asian dishes with tofu or meat options, and even hummus with pita. It’s like a cruise ship!” raves King.

With meals including Salmon a la Dijonnaise or Grilled Chicken Mandarin salad and a wrap with grilled vegetables with feta cheese, it’s easy to see why the menu has received just positive feedback from patients. But it’s not just tasty; it takes a lot of collaborative work to come up with menus that combine flavour with the strict nutritional requirements of a therapeutic diet. The barrage of media hype touting the next great super food, and TV doctors gushing about the powers of a particular food one day and then lambasting it the next, can be overwhelming to the general public. But Morelli and her colleague Ann Coughlin are not easily distracted by the noise when it comes to building menus for patients. “We don’t act on a particular study when we deliver our recommendations to patients and for menu development; we rely on scientific, evidence-based studies and reliable expert guidelines before making a significant change,” said Coughlin. “So if one study comes out claiming a food is miraculous and there’s a lot of media hype, we take it with a grain of salt.” Morelli laughs realizing her choice of words, “Or a salt replacement!”

Morelli and Coughlin consult the most recent research establishing nutritional standards for in building and tweaking recipes and menus, referring to the Canada Food Guide, the Order of Dieticians for Quebec, both the American and Canadian Dieticians Associations, and the American Society of Parenteral and Enteral Nutrition (ASPEN). They also apply specially designed standards that meet the needs of patients on renal, sodium controlled, and high protein diets. Sodexo, the institutional food service company that oversees the food production carried out in MGH kitchens then uses these standards and, in collaboration with Clinical Nutrition, creates meals that will appeal in taste and aesthetics, while delivering on nutrition.

Describing how the content and production of food has evolved at the MGH over the years, Morelli and Coughlin note there is a greater emphasis on preparing fresh foods rather than processed foods now. “We’ve also seen an increased incidence and awareness to food allergens and intolerances in both patients and staff, so there is a greater effort to ensure there is no cross contamination of food preparation.” Even the understanding of healthy amounts of sodium has changed drastically. According to Coughlin, it wasn’t that long ago when 3-5 grams of salt per day was considered acceptable for a patient who needed to limit their salt intake. Today, it is advised that the healthy people without a sodium problem shouldn’t have more than 2300 mgs – or about a teaspoon of salt per day – a fraction of what was recommended for low sodium diets in the recent past.

Patients now have a greater selection of fish and fibre-rich foods to choose from and there is a decreased emphasis on red meats. In order to address the growing demand for protein-rich vegetarian dishes as main courses, the menu now includes ingredients such as quinoa,” said Coughlin.

Patient Elizabeth King agrees that eating a fresh homemade soup is far more preferable to a tinned product. “It’s much healthier, tastier and contains only the amount of salt you put in. And it doesn’t really take that much longer to prepare.”

Though a small portion of the food is prepared offsite, it is all fresh and the nutritional quality adheres to all the standards set out by the Clinical Nutrition Department. Of those items that arrive in MUHC kitchens already prepared, there is a careful examination of the ingredient list to ensure that it is simple and short, and there is a minimal amount of processed food included. “We are attentive to how these items are prepared,” stressed Morellli, adding “Because of the increased awareness of allergies and intolerances, we track the ingredients in the foods that might trigger an allergic reaction or gastro-intestinal disturbance. Fewer ingredients make things easier to manage.”

For Morelli and Coughlin the appearance and flavour of the food are as critical as the nutritional value. “A meal can have optimal nutritional value, but if no one is eating it because it doesn’t taste good or looks unappealing, then what’s the point?” argues Morelli. Judging by the satisfaction survey collected at regular intervals by Food Services, the At Your Request program has been successful.

All this may not seem like a big deal to most people, but for patients with limited options and whose appetites might be vulnerable to their medications and conditions, that kind of independence can make the difference between a patient who is excited about eating to one who might give up on a meal altogether.