Starting From Scratch In More Ways Than One

The kitchen staff at the 283-bed Legacy Emanuel Medical Center in northeast Portland, Ore., was constrained, relying on Rolodexes and last-generation cook-chill technology to track and prepare nearly 1,000 patient meals daily. The department experienced a lag time of 18 hours to update dietary guidelines for patients, and virtually nothing was made from scratch.

Legacy Emanuel is a major healthcare provider in the Oregon market. As part of the Legacy Health network of six hospitals, it serves the region with highly specialized clinical services and has one of only two Level I trauma centers in the state.

The hospital knew it had to step it up in the face of competition. And with a new 150-bed pediatric bed tower opening in February 2012, the 80-year-old kitchen would not be able to keep up with demand. It was time to gut and rebuild.

Before reconstruction began, nutrition services team leader Colleen Peters, manager, wanted everyone on board, “because if you don’t have their buy-in, you’re dead.” She worked with every nursing unit and with hospital leadership to make sure the department addressed their concerns and prepared them for the operational difficulties that would arise during construction. Foodservices hosted food samplings for employees in inpatient and outpatient departments, and tweaked recipes based on feedback.

The nutrition services department turned to a hotel foodservice model with a menu featuring local ingredients cooked to order—a far cry from the old method of retherming food trays prepared at another site.

The department integrated the menu into a sophisticated dietary office system and an efficient delivery method. Opened in March 2010, the $4.5 million project took 18 months to complete—on time and within budget.

“It’s like night and day now that the project is completed and to everyone’s credit, they lived through it,” Peters said.

The Mothership Returns

Pre-renovation foodservice space totaled, 9,000 sq. ft., and basically comprised cold storage, a bank of convection ovens and an old tray line. After, space expanded to 12,500 sq. ft. and comprises an entire series of function areas that flow one into another and that allow the kitchen staff to fill all foodservice needs from patient meals to retail to catering in addition to baking, efficiently, safely and with quality.

About 3,500 sq. ft. of space is dedicated to new administrative and employee space, including a call center. Another 1,000 sq. ft. next to the main kitchen is set aside for catering (on and off site) and retail outlet supply. It supports three retail operations: the Courtyard Café, a traditional cafeteria serving 1,000 customers daily; the Heartbeat Café, a 24/7 operation serving made-to-order pizza, sandwiches, and grab-and-go selections; and the Kite Café, a small espresso and yogurt retail concept that will open in the new children’s hospital.

In the main kitchen, the designers specified large banks of Imperial walk-in refrigerators and freezers and five prep stations. The stations are designed to keep day-issue ingredients close at hand and provide easy access to such prep equipment as Hobart slicers, a Robot Coupe food processor, Edlund scales and Varimixer mixers along with lots of worktops, sinks and ingredient bins. The prep area also boasts a Traulsen safety thaw roll-in refrigerator.

Prepared ingredients flow to either bulk hot food production or the short-order line. Bulk hot food production features Cleveland tilt and steam-jacketed kettles and Alto-Shaam combi ovens and blast chillers. Here cooks prepare bulk foods such as potato and leek soup, rice, and creamy pesto pasta, as well as all roasts and whole poultry.

The short-order line to fulfill a la minute room service orders is equipped with a Montague charbroiler, gas range and griddle, and Frymaster fryers and pasta cooker. The department uses an induction-base heater to hold hot plates hot while in transit.

While Peters and her staff love every piece of new equipment, they give special kudos to their Turbochef oven, which is critical to the room service success. Pre-programmed cook settings make preparation of multiple menu selections fast and foolproof, and the ability to add special touches like browning and crisping give food a mouth-watering texture and appearance that cooks never achieved retherming in conventional ovens.

From the bulk hot line and short-order line, foods travel to meal assembly (where staffers assemble and load trays) and the beverage station, which is equipped with coffee and tea dispensers, blenders, soft serve machine and a Manitowoc ice machine with Follet dispenser.

Since this is the Northwest, coffee demanded special attention. Espresso beverages are not common in hospital room service, but Legacy Emanuel knew it had to live up to expectations. Designers installed a CMA espresso machine on the beverage line that produces lattes, cappuccinos, steamed espresso, caramel macchiato, and similar drinks that have been a huge hit with patients.

Hosts serve coffee drinks in temperature-resistant “Hold and Go” paper coffee cups inscribed with the hospital logo. No sleeve or double cup is needed, even when coffee is very hot.

Another 1,450 sq. ft.—far more than the old system—is dedicated to warewashing. The clean end of the washing line is next to the room service tray assembly line. That means clean trays are always nearby and ready for filling, and creates an effective, circular work-flow pattern. A Hobart flight-type dish machine and PowerSoak potsink (in a dedicated pot/pan wash area) are the workhorses of warewashing. Designers also put in a cart wash.

Although it may sound odd, the closed-off trash/recycling room is a luxury that helps the department maintain food safety by controlling and containing refuse.

Construction Challenges

With the nuclear medicine department directly above, construction never went smoothly. Workers had to halt jack hammering and other noise when patient procedures were underway, but Peters says everyone stayed pretty good natured about the situation.

Along the way, plans were revised three times because of unwelcome surprises such as hidden stairwells, elevator shafts and drains that had to be ripped out or bypassed.

During construction, Legacy Emanuel trucked in cold meals in retherm carts from a sister hospital and plugged them into Legacy’s retherm docking units so they could stay chilled until it was time to reheat.

Staffers had to relocate these docking stations several times as different sections of the kitchen underwent remodeling, (the renovation never interrupted meal service). Since refrigerators had to be removed from the space for six months, staff minimized refrigerated food requirements and relied on a refrigerator in one of the facility’s retail sites.

Legacy employees breathed a collective sigh of relief when the kitchen opened in March 2010. Aside from the revelry in the new kitchen, employees and patients throughout the hospital quickly realized the significance of the renovation as a fresh-food supply and distribution center.

Resort-Like Room Service

Room service with real-time patient information opened for business at the same time as the new kitchen. Legacy Emanuel purchased Computrition Hospitality Suite software that interfaces with electronic medical records (EMRs) to help fulfill patient’s meal requests accurately.

In conjunction with the software, Legacy Emanuel hired employees to serve as hosts and hostesses in each clinical unit to provide personal, expedient service between kitchen and bedside. All hosts had previously worked room service in hotels. Each employee distributes meals, answers questions, and removes trays after patients finish.

The program runs a call center located in the kitchen, which takes orders and prints tickets to the production line. It also lets hosts enter orders on laptops from patients’ bedsides.

Since meal delivery is guaranteed within 45 minutes, hosts on each unit must also track orders. Each host has a wireless cell phone to communicate to the supervisor or call center. Room service is available between 6:30 a.m. and 8 p.m.

The department purchased 10-tray carts for patient meal delivery. Hosts distribute meals within 10 minutes and return the cart to the kitchen. Separate carts used to collect dirty trays stay on the unit for up to an hour before hosts return them to the kitchen.

The Computrition system in the kitchen includes four computers so cooks can look up recipes, if needed.  The kitchen no longer has printed recipe books. Additional software provides up-to-date information for inventory, purchasing, forecasting and similar functions.

Delectable Hospital Food

The room service menu features innovative offerings such as steak chimichurri marinated in cilantro and citrus juice, pan-Asian salmon simmered in mushrooms, ginger and scallions, and cheese quesadillas served with pico de gallo, sour cream, or guacamole. Cooks reduce the carbs and cholesterol in many dishes by substituting brown rice, egg whites or soy yogurt.

For Executive Chef Brian Seto, CMRDP, the new kitchen provided the opportunity to get back to scratch with ingredients and equipment. He varies the menu with seasonal dishes using local ingredients such as blackberries, butternut squash, Oregon-raised beef and pears. For instance, in the fall, he poaches pears in cranberry-goji juice with cinnamon and star anise.

“The transition from a retherm process to cooking a la minute allows us to give our patients the best possible dining experience. Being able to cook on demand with fresh, seasonal ingredients, and then supplement them with a from-scratch sauce is the antithesis of institutional food,” says Seto, who recently took top honors in the first Oregon Hospitals Green Chef Challenge.

Ability to cook from scratch also makes it possible for the kitchen to reduce the number of meals conforming to dietary restrictions—such as sodium-reduced or pureed offerings—from 21 to seven, while still meeting all patients’ needs, including patients with diabetes. Satisfaction scores for foodservice have risen from 3.6 before the new kitchen to 4.3 after. Peters expects even higher numbers as the system gets fine-tuned and the department introduces new recipes.

She beams when trays come back to the kitchen with zero plate waste.

In the first year of kitchen operations, food costs decreased $200,000. Peters expects savings will keep rising. 

At a Glance

Name of Hospital: Legacy Emanuel Medical Center, Portland, Ore.

Number of Beds: Currently 283. A new 150-bed children’s tower opens February 2012

No. of Patient Meals per Day: Nearly 1,000

Date Facilities Opened: Kitchen and room service opened March 2010

Patient Menu Sampler: Steak Chimichurri, Quesadillas, Poached Pan-Asian Salmon, Grilled Flat Bread Pizza, Flourless Chocolate Cake, Espresso Beverages, Apple Cider, Yogurt & Fruit Smoothies

Cost of Project: $4.5 million

Manager of Nutrition Services: Colleen Peters, MS

Kitchen Design: Mike Kell, SSA Inc., Tampa Bay, Fla.

Equipment Coordinator: Kelman Acres, Smith & Greene, Portland, Ore.

Architect: Zimmer Gunsul Frasca Architects, Portland, Ore.

Engineer: KPFF Consulting Engineers, Portland, Ore.

Construction Management: Andersen Construction, Portland, Ore.

Room Service Consultants: Room Service Technologies, Tampa, Fla.