This has been quite the year for Dan Henroid, MS, RD, director of Nutrition and Food Services (NFS), and sustainability officer for UCSF Medical Center, and his staff. They've had a major operational expansion and made gargantuan adjustments to their services.

Brett Demy, a patient at UCSF Benioff Children’s Hospital San Francisco, can order meals, communicate with his doctor and watch entertainment from the bedside digital tablet. Photograph by Elisabeth FallOn February 1, 2015, 130 critically ill patients were moved to the new 289-bed UCSF Medical Center at Mission Bay from the main UCSF Medical Center campus and the smaller UCSF Medical Center at Mount Zion.

One of the world's newest state-of-the-art hospital complexes, the $1.5 billion UCSF Medical Center at Mission Bay focuses on patients' experiences every step of the way through their stay. The LEED Gold accredited facility — one of the first hospitals in California to achieve this honor — is the culmination of more than 10 years of planning and construction of the complex, which includes UCSF Benioff Children's Hospital San Francisco, UCSF Betty Irene Moore Women's Hospital, UCSF Bakar Cancer Hospital and the UCSF Ron Conway Family Gateway Medical Building.

The medical center also includes 4.3 acres of green space, including one acre of rooftop gardens. UCSF expects a smart irrigation system that automatically adjusts water output according to weather fluctuations and other water conservation innovations to save 4 million gallons of potable water a year. Designed with nontoxic materials, the hospital complex will use 50 percent less power than the average U.S. hospital.

The Mission Bay campus features several key new technologies not commonly found in hospitals. Examples include fully integrated communication systems, robotic transportation of food and supplies, and a bedside interactive patient care system.

"The integrated communications device allows for secure communications via text and voice over the hospital's Wi-Fi network," Henroid says. "The ability to use texting over a secure network allows for timely communication without having to answer the phone.

In addition to texting, NFS established an enterprise call center for the patient dining program. The call center allows patients from all UCSF Medical Center locations to communicate their meal selections and have the meal tickets print at the appropriate locations. The new automated call distribution system has the ability to monitor call center performance in real-time including the number and wait time of callers in the queue, and provides a callback feature to allow patients to request a call back, among other features. "The most important aspect of this system is providing the operations team real-time feedback to flex the number of call center agents to provide better customer service," Henroid says.

Robotic TUGs

Stacy van Landingham, RN, accompanies one of 25 robots that transport medicines, meals, recycling and waste, surgical instruments and lab specimens throughout the medical center. Photograph by Elisabeth FallOne of the more exciting technologies is the use of talking robotic carts or TUGs to transport material, including food. UCSF uses 25 TUGs at the Mission Bay campus with 6 dedicated to Nutrition and Food Services. "These robots are essential to executing an on-demand patient dining program," Henroid says.

Due to the site design, the kitchen is on the north side of the 6-story complex where the loading dock is located. The children's hospital with a majority of the patients resides on the south side of the complex. "The task of expediting meals from the north side to the south side up to the patient care units on floors 3 through 6 would be very labor intensive," Henroid says.

Unlike robotic transport systems often used in large hospitals, these can function in public spaces and transport smaller loads. NFS sends TUGs on-demand with up to 12 trays per delivery. Using the integrated communications service, the kitchen notifies the unit-based foodservice assistant (FSA) that a delivery is en route. If there are dirty trays to be sent back to the kitchen, the FSA can exchange the clean cart with meals with the dirty tray cart. The TUG stops right outside the dishroom and drops off the cart while continuing back into the kitchen for another delivery. A flashing light and audible alarm usually notify the dishroom staff that a cart is ready for cleaning and sanitizing.

Based on the first couple of months in operation, Henroid says the NFS TUGs are "working out great." The overall TUG system is highly integrated into the facility infrastructure with the ability to open doors, call elevators, and move out of the way when a fire alarm is called in addition to navigating through the nearly 1 million square foot complex. The NFS TUGs make 125 to 150 trips per day averaging approximately 20 miles per day. Though the TUGs are used in 6 other departments, the NFS usage is approximately 20 percent of the total utilization of the TUG system.

"This time saved has resulted in avoided labor cost and allows the FSAs to spend more time on the unit in front of patients," Henroid says. The NFS team has made many tweaks to optimize the TUG system and plans to add such services as food and supply deliveries to adjacent medical office buildings, and pizza delivery.

Leila Tabrizi, MS, RD, manager, Patient Food Services, UCSF Medical Center at Mission Bay, reviews the room’s tablet that displays one of the menu ordering screens. Photograph by Dan HenroidPerhaps the most innovative change is the interactive patient care (IPC) system and its meal ordering capability. The IPC system is integrated into the electronic health record (EHR) and the back end meal ordering information system. Almost every patient room is private with a 65-inch display panel and a 10-inch tablet computer integrated into the room. After confirming the patient's identity, the system provides the patient with customized information including pictures of their treatment team, the ability to view education materials assigned to them by their healthcare team, pose questions to their providers, and order meals in real time in addition to television and on-demand movies.

An orientation video educates patients on how to use the meal ordering portion of the system. Patients have the ability to order off the restaurant dining menu for the current meal period and two additional future meal periods including the ability to select the time for future meal deliveries.

Preliminary results for the meal ordering are extremely positive. Almost 50 percent of the meal orders for the Mission Bay campus come from the IPC system, and the call center is fielding fewer calls. The NFS department has designed some custom algorithms to prompt patients to make meal selection adjustments for certain therapeutic diets such as carbohydrate controlled, which reduces the need for the call center to contact the patient to make meal selection adjustments.

 Facts of Note

• Number of beds at UCFS Medical Center at Mission Bay: 289
• Number of meals annually at UCFS Medical Center Mission Bay: 750,000, including 150,000 patient meals, and 600,000 meal equivalents for retail and catering
• Annual foodservice budget: $12 million
• Foodservice staff: 110 employees, including 90 FTEs
• Website: www.ucsfmissionbayhospitals.org

Innovators

• Dan Henroid, MS, RD, director of Nutrition and Food
• Services, and sustainability officer, UCSF Medical Center
• Ami Bhow, RD, associate director, Nutrition and Food Services, UCSF Medical Center at Mission Bay
• Leila Tabrizi, MS, RD, manager, Patient Food Services, UCSF Medical Center at Mission Bay