The Backstory

Health food

Behind the scenes in a hospital kitchen

At 12:17 p.m., Jose Tristan picks up the phone in his Stanford Hospital room to order lunch. It’s a Wednesday in October. Four days earlier, Tristan, 43, missed a dose of medication he takes for chronic obstructive pulmonary disease and ended up in the hospital, struggling to breathe.

As part of his treatment, Tristan was already on a low-sodium diet, and his doctor at the hospital has prescribed an even lower one. His phone call will start a countdown for delivering a meal of his choice.

Stuart Bradford illustration

“It’s like ordering room service,” said Jodi Krefetz, director of food services at Stanford Health Care. For the past eight years, anytime between 6 a.m. and 9 p.m. patients have been able to order from a menu of fresh, seasonal items designed with deliciousness in mind — including more than 30 breakfast items, a few dozen sides and snacks, and about 25 lunch and dinner entrees, many of which can be personalized to patients’ taste.

But patients’ needs go beyond flavor. The hospital’s food service team prepares 1,300 meals a day to meet nutritional standards of more than 100 different diets. They count carbohydrates for diabetics, accommodate food allergies, puree food for people who struggle to swallow, and offer choices to fit varied religious and cultural dietary practices. And they do it all within a 45-minute time constraint.

“A lot of your choices are taken away in a hospital setting,” said Helen Wirth, administrative director of hospitality services at the hospital. “For our patients, having some control is really, really important.”

Diets prescribed for medical reasons limit patients’ choices, of course. “Being a low-sodium patient, it’s hard,” Tristan said. His call to order lunch reaches a dietary assistant, who talks him through the menu. He asks about breaded baked fish, but it has added salt, which isn’t allowed on his diet, she explains. Does he want steelhead trout? He chooses meatloaf. He also requests gravy, a baked potato with margarine and sour cream, peas, white rice, iced tea with sugar, and vanilla ice cream.

The assistant enters everything into the food-service computer system and checks that Tristan’s selections contain less than the 550 milligrams of sodium he’s allotted per meal.

“A lot of your choices are taken away in a hospital setting. For our patients, having some control is really, really important.”

Three minutes after she starts his order, #519, the assistant saves it and it’s automatically printed in the hospital’s kitchen. There, staff on the hot-food line use clipped kitchen-speak while dishing up the potatoes whose aroma permeates the room. The place vibrates with activity: Equipment beeps, plates clank, people work shoulder to shoulder. (The new hospital, to which the team moved soon after this story was written, affords them 7,000 more square feet of space.)

By 12:27 p.m., a cook is heating Tristan’s meatloaf in beef broth in a high-speed oven. When it’s ready, a second cook adds the baked potato, gravy, rice, peas and a garnish in rapid succession. The plate goes in a warming vessel.

At 12:36, order #519 reaches a worker who adds utensils and condiments. At the refrigerator case, another staff member completes his meal. By 12:40, the team’s checker is comparing everything on the tray with the original order.

The meal is loaded onto a cart at 12:42, headed to the hospital’s third floor. The seventh and final person who handles Tristan’s meal, the tray passer, scans the bar code on order #519. A computer at the kitchen exit, synced to Tristan’s electronic medical record, would alert her if he had moved or his dietary requirements had changed while the meal was being prepared. The tray passer rolls the cart on a service elevator at 12:45.

Finally, at 12:49 p.m., the tray passer delivers Tristan’s lunch to him, 32 minutes after he placed the order. It’s a small but important step in helping him recover and head home.

Erin Digitale is the pediatrics science writer in the Office of Communications. Email her at digitale@stanford.edu.

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