Transforming Care at the Bedside: Patient-Controlled Liberalized Diet

The Transforming Care at the Bedside (TCAB) program was initiated in 2003 by the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement. The program is unique in that it puts front-line staff in the role of innovating and evaluating new processes and procedures. This study considers the implementation through TCAB of a patient-centered approach to inpatient dietary management at the University of Pittsburgh Medical Center. Named the Patient-Controlled Liberalized Diet Program, it was designed to improve the nutritional status and satisfaction among patients during their hospital stay. Mandatory restricted diets (unless absolutely necessary) were eliminated; instead, patients were able to choose what they wanted to eat.

Key Findings:

  • Dieticians spent more time on patient education and less time on providing food that patients did not want to eat.
  • Greater collaboration between nurses, dieticians, physicians and speech pathology staff.
  • At six months, there was a 58 percent increase in the number of patients who rated the food service as exceeding expectations or greatly exceeding expectations.

Bringing patients into the dietary decision-making process is at the heart of patient-centered care. By observing what patients choose to eat, nutritionists can begin the education process at a more realistic point.