Using a Pictorial Menu in Hospital Enhances Patient Satisfaction Without Improving Nutritional Intake or Plate Waste: A Pre-Post Mixed-Methods Pilot Study

Abstract

Introduction: Changes to the hospital meal ordering process can improve the suitability of meals by providing support and guidance to the patient. There is limited research on the effects of using hard copy pictorial menus alongside electronic bedside spoken meal ordering. Aim: To investigate whether the addition of a pictorial menu decreases plate wastage, increases patients' energy and protein intake and improves patient and staff experiences of meal ordering, compared to verbal electronic bedside meal ordering alone. Methods: A pre-post mixed-methods pilot study was undertaken at an Australian metropolitan acute care private hospital. The study included 245 inpatients on two wards, who consumed three consecutive main meals. Patients receiving fluid-only diets, enteral or parenteral nutrition were excluded. Meal intake data were collected using a visual six-point scale pre- and post- pictorial menu implementation. Patients and staff were surveyed on their experience and perceptions of the pictorial menu. Results: The introduction of the pictorial menu increased patients' confidence in knowing their order by 13.7% (p = 0.021). The appearance of meals were more likely to meet patients' expectations (p < 0.001), and patients' felt they received the assistance they required (p = 0.002). There were no significant changes in patients' energy and protein intake; however, plate wastage significantly increased (p < 0.001). Staff found the pictorial menus helpful but sometimes impractical to use. Conclusion: Pictorial menus improved patient experience and received mostly positive staff feedback. However, they increased plate wastage and did not alter patients' nutritional intake.