Dietician has an interface to the Clinicom system, which is the main source for obtaining patient data. All relevant changes to a patient's status are communicated hourly from Clinicom to Dietician.

Every ward in the hospital has a person responsible for ensuring that the data is correct in time for every meal. Full facilities for maintaining patients data manually through the user interface are available in case the data received from Clinicom is incorrect or untimely.

The kitchen staff print a report listing all the meal requirements of every ward before breakfast each day. The printing of this report is not repeated before lunch and supper. A report listing only the changes to the morning's full list is utilised (in conjunction with the day's full list) for these meals.

In addition to the above reports, the kitchen also prints a set of meal tickets for every meal. One ticket is printed for each patient that requires a non-standard meal. That ticket lists the ward number, the patient's name and the type of meal. Only one ticket is printed for all standard meals per ward. The majority of meals made by the kitchen are standard meals.

TBH differs significantly from the other hospitals in that meal tickets are returned from the wards back to the kitchen, sorted and re-used. While the tickets are sorted they are ticked of on the full report to ensure that a full set of tickets are present. Tickets for full meals are printed for every meal.

The kitchen has specific cut-off times for meal orders. The current Dietician system has a mechanism for keeping changes made to meal list separate in order to produce the kitchen report consistent with how it appeared at the cut-off time.

1.1.1. Groote Schuur

Groote Schuur is currently partly utilising a manual system and partly the Clinicom dietary patient requirement reports. The kitchen accepts the Clinicom reports only from a number of wards that have shown their competence in keeping the Clinicom database up to date. The remainder of the wards have to write or type the list of meals required and sends it to the kitchen via pneumatic tube.

The kitchen clerks combine the Clinicom and handwritten reports and manually produce meal tickets for every meal. These tickets are colour coded according to dietary requirements to make identification easier and eliminate errors.

The managerial and admin staff of GSH are only partially satisfied with Clinicom. They have two complaints about the system:

It caters only for the main kitchen and not for tube feeding requirements.

GSH handles cut-off times differently from TBH. They do not want to ignore entries after the cut-off time. Instead they want to be able to print reports or meal tickets of patients that have been entered after they have printed their initial list for the meal. The wards should then phone to notify them that changes have been made. They will then print the report containing the last few changes and send those few meals to the wards in question.

Currently orders for last-minute admission are ordered by phoned from the wards and are not reflected on ward reports. The kitchen management suspects that that causes abuse of the system by hospital staff to get meals for people not legitimately entitled to them. They require the system to log such late orders.

GSH has no separate mechanism for high turnover wards, and does not require reports that list statistics per conveyor belt.

1.1.2. Red Cross Children's Hospital

At RXH the ward staff fills out diet sheets once a day. The diet sheets specify meals in the following categories:runs on a Unisys mainframe and uses terminal emulation software as a user interface.

• Fullruns on a Unisys mainframe and uses terminal emulation software as a user interface.
• Toddler
• Baby
• Special diets
• Entral feeds

The kitchen supervisors receives these diet sheets and compiles a summary of all meals required. Special diet meals are not included in the summary - their requirements are written out in triplicate for the three meals of the day. Wards notify the kitchen of new patients by sending routing slips to the kitchen.

The food for standard meals are sent to the wards in bulk. These meals get dished up onto plates at the wards. Special diets are dished up onto plates in the kitchen.

RXH has a milk kitchen that is similar to but separate from the bottle feed kitchen. The milk kitchen gets their orders on a feed slip specifying a recipe, volume required and a code that gets mapped to a patient at the ward.

RXH requires a diagnoses to be associated with a patient.