There’s a Lot That Goes into Making the Sausage at a VA Hospital

Registered Dietitians operate in three main roles in the VA Greater Los Angeles Healthcare System (VAGLAHS): administration in the West LA VA Medical Center campus food production facility, in various inpatient clinical roles, and in various outpatient clinical roles.

The kitchen here runs a 21-day cycle menu, with multiple alternate options built into the menu to accommodate various patient preferences, said Megan Richardson, MS, RD, Administrative Section Chief for the administrative dietitians. 

She said the residents of the Community Living Center also have the option to order grilled items from the kiosk, located in Bldg. 215, which just reopened after being shut down a few years ago due to COVID. The patients can request grilled cheese, quesadilla, burgers and eggs all day long. “They're pretty much only eating the grilled food right now because they're so excited that it's back.” 

The menu also frequently requires changes within the 21-day period due to supply chain issues, which was especially challenging during COVID, and there are contingencies in place to swap out foods last minute, said Richardson.

The registered dietitians also utilize many types of diets to address special needs.

There’s a soft diet for easy chewing, a puree diet for those with issues swallowing, a consistent carbohydrate diet for management of diabetes, a low-salt or low-fat diet for patients with cardiology concerns, a diet for patients receiving PET scans, renal diets for patients with kidney issues, a Kosher diet, and even a vegan diet, said Roger Chou, RD, Inpatient Section Chief for Clinical Nutrition.

The inpatient dietitians perform comprehensive nutrition assessments and work closely with the patient’s medical team to address any nutrition concerns, he said. They’ll examine the Veteran’s diet order history in the medical record to see if the appropriate diet is ordered, assess their intake history, or whether they notice any significant weight trends. 

Patient preference also plays a part in what food is served.

There are two health techs whose primary role is to visit patients at Bldg. 500 (the main hospital) and the Community Living Center to talk about patient food preferences, Chou said. 

It’s also important to provide the Veterans with as much control of their environment as possible.

“Let's say, somebody just had a severe stroke, they can't speak, they can't raise their arm,” said Jennifer Karp, MPH, RD, Assistant Chief, Nutrition and Food Services, who oversees clinical nutrition operations for VAGLAHS. “It's really important to give dignity in the healthcare setting, especially when somebody who's been in control of their life and their activities can no longer do those things. Food is one thing that the Veteran eventually does feel empowered by, because if you can't control much else in your life, then there's one thing that typically people do focus on and that's often going to be food.”

All of these different diets play into managing the supply chain as well.

“If a food can go across multiple diets, that's a win because then we can serve it to no matter what kind of people patient population we have,” said Karp. “The drawback, of course, is that if you have to make an adjustment now, you're making adjustments to a large volume of trays.”

Once the diet is set, they also have checks in the food preparation line to ensure that the right meal gets to the right patient.

“We use a software system, called Computrition, that interfaces with the Computerized Patient Records System to access a patient’s medical records with links to their allergies and diet,” said Richardson. Then the ticket office runs a program called Smart Subs which will find the appropriate menu items that are on hand for the day for each patient based on their allergies and diet, likes, and dislikes as well.

“Then we have the highest graded service worker, which is a WG-4, checking at the end of the tray line and then once again when the food goes out to the galleys, the tray passer will check the tray for accuracy and add hot beverages and frozen desserts,” she said.

Education for Veteran patients also plays an important role in the responsibilities of Dietitians at VAGLAHS.

Karp said that their diet education is always Veteran-centric, based on how the Veteran prefers to learn, which may incorporate handouts, verbal instruction, or hands-on training. 

“We may get a patient that says, ‘I'm just a meat and potatoes kind of guy and I know I need to be eating XYZ for my heart,’” said Karp. “We want to meet somebody where they're at; that's the only way, and if somebody has a lot going on, we don't want to overwhelm them. It’s too much to expect of anyone to make drastic, sweeping changes, so we'll ask them, what do you want to work on?”

She said that for a patient dealing with a diabetic crisis, for example, they may focus on how to count and adjust their carbohydrate intake. If that still feels like too much, they’ll make it even simpler and show a plate with how much protein, vegetables and complex carbohydrates should cover a given portion of the plate. “We can go deep and advanced or keep it very simplified.”

VAGLAHS Registered Dietitians consistently seek new ways to improve their offerings for Veterans.

Richardson said she’s looking forward to hiring an executive chef in the future to offer comprehensive cooking enhancements and menu consultation.

For those interested in working in a career in planning, making or serving food, VA jobs are listed on www.usajobs.gov.