Table 1.
Study Characteristics and Outcomes of Included Studies
| Author; Year; Study Design | Setting, Location | Participants | Description of Intervention | Description of Control | Outcomes | Fidelity Issues Reported |
|---|---|---|---|---|---|---|
| Beck et al;20 2017; Semi-structured interviews with patients post-intervention | 2 neurological wards, Denmark | n=13 patients | Intervention “Quiet Please” developed based on PM tailored to the local context. | Not applicable | 3 themes emerged: the importance of the bell prior to mealtimes; calmness and aesthetics; a trust-bearing agreement | Not measured quantitatively. Patients described feeling disappointed when the mealtime intervention was not implemented by staff. Where this occurred patients reported feeling frustrated and some distrust of staff. |
| Goarley et al;21 2019; Quantitative pre-post study | 1 non-acute hospital unit, Canada | n=33 adults Observations were made for 4 days before and after PM implementation |
PM implementation focused specifically on interruptions and mealtime assistance | Pre-intervention ward conditions not reported | Mean energy per person/day increased 6715kJ to 7096kJ (increase 5.4%); mean protein intake per person/day increased from 60.1g to 64.7g (increase 7.2%) | Number and length of interruptions decreased (46.6% and 25.2%), average length of assistance increased (26.4%) |
| Hickson et al;22 2011a; Quantitative pre-post study | 40 pre- and 34 post-intervention wards across 2 acute hospitals, England | Pre-intervention: n=253 patients observed for patient mealtime experience; post-intervention: n=237 patients observed for patient mealtime experience | PM introduced through guideline document, Hospital staff dissemination, Intranet messages, large PM signage at mealtimes | Pre-intervention ward conditions not reported | Mean±SD: Energy intake meal pre-intervention: 1281 ±1017 kJ/per meal, post-intervention: 1093±1068 kJ/per meal; protein intake pre-intervention 15.0±11.6 g/meal, post- intervention 10.6±11.2 g/meal. |
Mealtime environment observations (ward level): no statistically significant improvements (at p≥0.05) but improvements reported in some observations. Statistically significant improvements in some patient-level observations, eg patients offered opportunity to wash hands, table clean and clutter free. |
| Huxtable et al;23 2013; Quantitative pre-post study | 6 acute hospital wards, Australia | n=799 meals pre- and n=833 meals post-intervention | Range of PM strategies implemented; volunteers also introduced to provide mealtime assistance. | Pre-intervention ward conditions not reported | All meals (mean± SD): energy intake: pre-intervention 1466±660 kJ, post-intervention 1467±635 kJ (p = 0.979); protein intake: pre- intervention 15±7 g, post-intervention 15± 7g (p = 0.482). Protein (breakfast): pre-intervention 10±5 g, post-intervention 12±6 g (p = 0.025). |
Patients receiving mealtime assistance was unchanged (p=0.928); feeding assistance increased from 15–29% (p=0.002); interruptions were less likely to occur pre-PM. |
| Jefferies et al;24 2015; Quantitative pre-post study | 14 pre- and 20 post intervention wards across 3 hospitals, Australia | n=435 (pre) and n=422 patients (post) observed at mealtimes; n=226 (pre) and n=240 patients (post) completed a food satisfaction survey | Locally developed policy based on UK PM model | Pre-intervention ward conditions not specifically reported, volunteers were available | Patient satisfaction was reported using the locally developed Patient Food Satisfaction Survey. Significant improvements noted in statements relating to amount of food received and meal tray appearance, but no other statements. | No statistically significant difference in the mealtime assistance required, most patients required limited or no assistance. Where feeding assistance was required, most patients received adequate levels of assistance: pre-PM 82.7%, post-PM 883% (p-0.058). Use of bedside signage and nursing notes improved significantly, as did use of carers for provision of mealtime assistance. No statistically significant differences in other mealtime observations reported. |
| Ng et al;25 2010; Quantitative pre-post study | 1 specialist diabetes unit, England | n=136 pre- and n=158 post- PM implementation | PM based on Hospital Caterers Association; 1 hour was allocated for PM at each of 3 meal periods. Except for emergencies, staff were refrained from interrupting patients during this period, including the administration of anti-diabetes therapy. | Pre-intervention ward conditions not reported | Mean blood glucose (mmol/L [±SE]) pre-PM 10.7±0.33, post-PM 10.6±0.32, p=0.79; incidence of hypoglycaemia (CG <3.5 mmol/L) pre-PM 20.4%, post-PM 25.2%, p= 0.36; mean length of stay (days) pre-PM 3.7, post-PM 4, p=0.11 |
Not reported |
| Porter et al;26 2017; Stepped wedge cluster randomised controlled trial | 3 subacute wards in 3 hospitals, Australia | n=149 participants, with n=210 24 hour meal observations made in control period, n=206 meal observations made in observation period | Intervention designed according to the British Hospital Caterers Association PM reference policy and by principles of implementation science. | Patients continued to receive usual mealtime care which did not include PM. | Energy intake (kJ/day) (mean±SD): control 6532 ± 2328, intervention 6479 ± 2486, p=0.876; Protein intake (g/day) (mean±SD): control 67.0 ± 25.2, intervention 68.6 ± 26.0, p=0.860 | Fidelity was variable. Between control and intervention the number of positive interruptions increased in number and length, number of negative interruptions decreased; ward entry doors were closed more (9 control vs 23 PM), meal sign displayed (13 control vs 31 PM); other changes were limited. |
| Young et al;27 2013; Quantitative pre-post study | 1 acute hospital, Australia | Pre-intervention: n=115 patients 79.4±7.9 years; post-intervention: n=39 patients 82.8±7.7 years | No changes to staffing; strategies negotiated with clinicians and support staff for PM introduction including: - limit non-urgent activities and interruptions at mealtimes - re-prioritise clinical tasks to focus on meals at mealtimes - clinical staff to encourage and assist patients with nutritional intake |
Established malnutrition screening and nutrition support policies implemented. No mealtime procedures with mealtime assistance provided by nursing staff in an unstructured manner | Mean±SD: 24hr energy intake: pre-intervention 5011±1774 kJ, post-intervention 4957±2237 kJ; protein intake: pre-intervention 47±19g, post-intervention 43±21g. Intake (mean per kg): Energy: pre-intervention 75kJ/kg, post-intervention 76kJ/kg; protein: pre-intervention 0.7g/kg, post-intervention 0.7g/kg. |
Mealtime assistance increased from 30% pre-PM to 80% post-PM; mealtime interruptions decreased from pre-PM 38% to 33%; reduction in non-clinical nursing tasks during mealtimes from pre-PM 66% to 27% post-PM. |
Notes: aUnpublished nutritional intake data (mean ±SD) provided previously by authors for 39 patients pre- and 60 patients post-intervention. 1 kilocalorie= 4.18 kilojoules.
Abbreviation: PM, Protected Mealtimes.