Patient Services: Week One

Week one of rotations is officially crossed off the list! I've learned so much this week: in classes, my rotations, and through others I've met along the way.

Monday and Wednesday are class days. Our first day was a total breeze. Our professor for two of our classes wasn't there, so we were handed our syllabi and scooted out the door. Easy enough! We also took a test on all the topics we've covered so far: enteral/parenteral nutrition, diabetes, the nutrition care process, and nutrition assessment. (It was really nice to have "pre-classes" before we got into the clinical rotations so that all the interns are on the same page as far as expectations from the hospital are.) Wednesday we had our first real day of classes. I'm taking two Nutrition Research classes, but from looking at the syllabus, I am pretty sure it's going to be very similar to Nutrition Counseling. And, I loved that class, so bring it on!

On Tuesday I was able to meet my preceptor, Ray. He is a native Spanish speaker, so when he gets really excited about something, you REALLY have to pay attention! (Our internship director always yells at him, apparently, "Ray! Spanglish! You're speaking Spanglish!")  Because he is the director of the A La Carte Patients Services area, he is a busy man. This rotation focuses mainly on the management aspect of dietetics, so my first projects were attending meetings, evaluating cycle menus, and reviewing food safety with supervisors.

Patient Services is somewhat unique in that the way patients receive trays is by means of a call center. Patients receive a menu and are then instructed to call down to order their trays. My favorite project is evaluating patient trays. I get to be a "secret shopper" and call down to the call center, order whatever I want off the menu, and fill out an evaluation of my experience. I rate the friendliness of the employee, food texture, temperature, quality, and if everything I ordered was on the tray. I have experienced both ends of the spectrum when I get the tray I ordered. The first day I did it, I was sent a ground chicken sandwich instead of a grilled chicken sandwich. Ground chicken is usually saved for people who have swallowing problems (i.e. dysphagia diet!). Needless to say, it wasn't the tastiest thing I've ever eaten. The next day though, I ordered a bean and cheese enchilada with fruit and cottage cheese---much better!

Another project I have been working on with another intern is recipe standardization. We chose a recipe (from Iowa Girl Eats, of course) and are turning it into a recipe that can be made in larger batches. Basically, what we do is make the recipe one time exactly how it says to on the recipe provided. As we go, we weigh out all ingredients on a food scale, and record them. The reason for this is to make the recipe CBORD-compatible. CBORD is a computer program that holds all the recipes at the hospital in a standardized format. From this program, it is really easy to switch to a recipe that serves 80, rather than 5. It also provides nutrition information for the recipes. Because hospitals are held to standards for the amount of fat, carbohydrate, sodium, etc., it is important that the recipe we make provides proper amounts of everything. If it doesn't we will have to make the recipe again and make it fit into the standards. After all this is taken into account, we make changes to the recipe according to how it tasted the first time. For example, the first time we made our recipe, there was an overabundance of cumin, and very few vegetables. The second time we made it, then, we tripled the amount of vegetables and cut the cumin amount by two thirds. This time, the food tasted SOOO much better! We still have more to work on (like putting the recipe and weights into CBORD), so we will continue with that tomorrow.

I was also really lucky to attend a number of meetings with my preceptor's boss, Doug. He invited me to go along with him to a meeting for "higher up" management (the CFO and COO of the hospital were there!). I sat between him and Laurie, my internship director, and they introduced me to a number of other people they collaborate with on a daily/weekly basis. The meeting was two hours long (so long, in fact, that part way through, Laurie turned to me and said, "This taking foreverrr...so...what's your new last name going to be when you get married?") and covered topics like patient satisfaction, employee awards, the release of the new menu for patient services, construction of the new Children's Hospital, the grand opening of Iowa River Landing (the new outpatient clinic), and where to park on Hawkeye game days (since the stadium is right across from the hospital). Interesting stuff. A lot of it went over my head, but it was still nice to be included and introduced to some hospital big wigs!

So far, working at UIHC has taught me to expect the unexpected. In school, a lot of topics were skimmed over because "you won't see patients with (insert complicated condition here) hardly ever". They forgot to add "...unless you are working at the largest teaching hospital in the state of Iowa"! That just means that I'm learning a TON. Slowly, but surely. I am absolutely loving my internship, and I would be happy to give any undergrads a tour ;)