European Journal of Clinical Nutrition (2015) 69, 961–965

© 2015 Macmillan Publishers Limited All rights reserved 0954-3007/15

www.nature.com/ejcn

ORIGINAL ARTICLE
Aspects of protected mealtimes are associated with improved
mealtime energy and protein intakes in hospitalized adult
patients on medical and surgical wards over 2 years
M Palmer and S Huxtable

BACKGROUND/OBJECTIVES: Protected mealtimes programs aim to improve inpatient intakes. Yet its efficacy has not yet been
established. We aimed to determine which patient-related factors and aspects of protected mealtimes, for example, mealtime
assistance and meal within reach, were associated with energy and protein intakes of adult inpatients on medical and surgical wards.
SUBJECTS/METHODS: Patient characteristics and dietary intake data were collected at main meals over 2 years. Proportions of
individual foods and drinks consumed were visually estimated and converted to nutrients using averaged ready reckoner data.
Mealtime factors associated with energy and protein intakes were determined using multivariate linear hierarchical regression analyses.
RESULTS: Over 2 years, mealtime nutrient intakes of 798 inpatients were calculated ((63 ± 19) years, 52% male). Average intakes at
main meals were 1419 ± 614 kJ and 15 ± 7 g protein. Inpatient intakes were significantly associated with gender, age, season,
stopping or refusing a meal, time until discharge and eating at dinner (B = − 829–222 kJ, B = − 8.8 to 2.2 g protein, P = 0.000–0.032).
Protected mealtimes program implementation was not associated with inpatient intake (P = 0.094–0.157). However, aspects of
protected mealtimes were associated with intake. This included requiring and documenting the need for mealtime assistance,
introduction of mealtime volunteers, time to eat and appropriate positioning during mealtimes (B = 177-296 kJ, B = 0.07–3.9 g
protein, P = 0.000–0.014, R2 = 0.148–0.154). In those specifically requiring mealtime assistance, inpatient protein intake was
associated with mealtime volunteers and appropriate positioning (B = 4.1–4.4 g protein, P = 0.013–0.026, R2 = 0.197).
CONCLUSIONS: Aspects of protected mealtimes were associated with improved intake. Identifying these achievable aspects during
planning and ensuring successful implementation of protected mealtimes may be critical for optimizing acute inpatient intake.
European Journal of Clinical Nutrition (2015) 69, 961–965; doi:10.1038/ejcn.2015.87; published online 3 June 2015

INTRODUCTION However, few studies have specifically examined the benefit of

The implementation and evaluation of protected mealtimes
programs is still in its infancy. Protected mealtimes programs
have been implemented in o 10% of Australian and New Zealand
hospitals surveyed in 20101 and o40% of trusts in England and
Wales.2 Two recent reviews highlighted the limited published
literature evaluating the efficacy of protected mealtimes in
improving energy and protein intakes in acute care settings.3,4
Based on the limited studies published, the efficacy of
protected mealtimes in improving mealtime energy and protein
intakes has not yet been established. An Australian study in elderly
inpatients showed no differences in energy and protein intakes
after implementation of protected mealtimes and/or mealtime
assistance; however, inpatients were more likely to meet daily
energy requirements post implementation (pre:8% vs post:
20–31%, P o 0.01).5 Other studies6–10 have not checked whether
protected mealtimes was successfully implemented, and used a
variety of strategies to implement the program (such as staff in-
servicing, signage on wards). Thus no conclusion can be drawn
from their results that show no changes in energy and protein
intake. If protected mealtimes was not successfully implemented,
then no change in intake could be expected. Young et al.5 also
showed that significantly more patients with feeding dependency
met daily energy requirements when protected mealtimes
and/or mealtime assistance interventions were implemented.
protected mealtimes in patients at particular risk of poor intake,
including those who require mealtime assistance.5
We intuitively assume that implementation of protected
mealtimes will result in improved inpatient intakes. The risk is
that protected mealtimes programs will not be adopted in
hospitals worldwide if there is a lack of evidence to support its
implementation. As such, we aimed to determine which aspects of
protected mealtimes were associated with energy and protein
intakes of all adult inpatients, and in those requiring mealtime
assistance, on medical and surgical wards after controlling for
patient-related factors that may be associated with intake.
PATIENTS AND METHODS
This is a secondary analysis of a pre–post study evaluating the
implementation of a protected mealtimes program. Methods have been
described previously.6 This study was exempted from ethical approval by
the Metro South Health Service District Human Research Ethics Committee
(HREC/12/QPAH/106).
The protected mealtimes program
Protected mealtimes program implementation was staggered across acute
medical and surgical adult wards at Logan Hospital from January 2011 to
January 2012. Intensive care, mental health, pediatric and maternity wards

Department of Nutrition and Dietetics, Logan Hospital, Queensland Health, Meadowbrook, Queensland, Australia. Correspondence: Dr M Palmer, Department of Nutrition and
Dietetics, Logan Hospital, Queensland Health, Armstrong Road Logan hospital, Meadowbrook 4131, Queensland, Australia.
E-mail: Michelle.palmer@health.qld.gov.au
Received 21 July 2014; revised 11 March 2015; accepted 11 April 2015; published online 3 June 2015
 Protected mealtimes and patient intake
M Palmer and S Huxtable
962
were excluded. In-services were held on wards pre- and post implementa-
tion which ~ 58% (n ~ 122/210) of all permanent staff attended. Medical,
Medical Imaging and Allied Health staff also attended in-services to discuss
barriers to implementation of the project and ways to decrease inpatient
procedures during mealtimes. Foodservice staff was educated on the
importance of placing meal trays within patient’s reach and delivering and
collecting trays in a way that maximized the time provided to patients for
eating. Posters on wards displayed times reserved for protected mealtimes,
requests for priority given to meal trolleys delivering food, keeping tray
tables clear and within patient’s reach, and requests for staff and visitors
to provide mealtime assistance. Volunteers were introduced to four wards to
provide patients with mealtime assistance during implementation or up to
8 months post implementation of protected mealtimes. Volunteers were
able to assist at mealtimes with tasks such as meal tray being within reach,
setting up meals, providing encouragement and opening packages;
however, volunteers did not provide feeding assistance to patients.
Data collection
Data collection occurred between August 2010 to December 2011
(pre-protected mealtimes implementation) and June 2011 to June 2012
(post-protected mealtimes implementation). Mealtime observations were
collected over breakfast, lunch and dinner on weekdays across all
acute care medical and surgical wards by dietitians as workloads
permitted. Observations were excluded if people were discharged from
the hospital, nil by mouth, away for a procedure, fed enterally or
parenterally, had refused their meal or were sleeping and did not eat
anything, or consumed only food and drinks from outside of the hospital
foodservice system.
Data were collected for each patient about the following aspects of
protected mealtimes: if mealtime assistance was documented as required,
if mealtime assistance was observed to be required, if mealtime assistance
was provided, if volunteers had been introduced to ward at time of
observation, whether patient was appropriately positioned during meal,
time of delivery and collection of meal tray, whether meal was within
patient’s reach and number of interruptions during mealtimes. Patient’s
diet code was also collected. The proportion of individual foods and drinks
consumed (for example, o1/4, 1/4–o 1/2, 1/2–3/4 and 43/4) was visually
estimated. Estimated energy and protein intake using visual estimation of
portions consumed have previously been validated against weighed intake
in acute care settings.11–13 After intake data were collected on the pilot
ward, changes were made to the consumption section of the data
collection sheet to improve its accuracy. This meant that the pilot ward
dietary consumption data prior to protected mealtimes implementation
were not analyzed (n = 133 observations). Gender, age, brief presenting
condition and medical history and whether mealtime assistance was
documented as required were sourced from a dietary and handover
management program (Trendcare, Murrarie, QLD, Australia). Patients’
admission and discharge date were sourced from medical records.
Mealtime assistance encompassed any type of assistance required at
meals including setting up meals, cutting up food and providing feeding
assistance. Nursing care plans in patients’ bedside charts and the electronic
dietary management system were checked to see if each patient was
documented as requiring assistance. Patients were also considered to
require mealtime assistance if they had a purple lid on their tray, or were
observed to require mealtime assistance using clinical judgment. The
purple lid alerted nursing staff and volunteers that the patient required
mealtime assistance, similar to the red tray system in the UK.14
Certain medical conditions may predispose patients to having poor
appetite. A patient was classified as increased risk of poor appetite, and
hence greater plate waste, if their presenting condition and medical
history included the following: cancer, palliative care, confusion, delirium,
dementia, respiratory or chronic obstructive pulmonary disease, fractured
neck of femur, cardiovascular accident, constipation, diarrhea, vomiting,
diseases related to alcohol abuse, non-mechanical falls or were older than
85 years. Diet codes that included texture modification, high-protein high-
energy and/or thickened fluids were also classified as associated with poor
appetite.
The proportion of foods and drinks consumed was converted into
energy and protein using averaged nutrient values of foods or drinks
within the same category. Nutrient information was sourced from suppliers
and Foodworks (Kenmore Hills, QLD, Australia). Weights of food and drink
items were sourced from a recent foodservice audit. Nutrient totals for
each main meal were then calculated.
European Journal of Clinical Nutrition (2015) 961 – 965
Statistical analysis
Descriptive analysis, χ2 and independent samples t-tests were used to
report patient demographics, mealtime information and consumption
before and after protected mealtimes implementation. Multivariate linear
hierarchical regression analysis was conducted to identify aspects of
protected mealtimes that were significantly associated with mealtime
energy and/or protein intakes for all patients at their first mealtime
observation, and also for those patients who required mealtime assistance.
Multivariate linear hierarchical regression analysis was additionally
conducted to identify aspects of protected mealtime that were signifi-
cantly associated with mealtime energy and/or protein intakes for all
mealtime observations collected (that is, patients may have had more than
one mealtime observation taken). Collinearity was checked prior to
analysis.
Demographic, mealtime and hospital-related variables that may often be
associated with intake were controlled for in Model 1 of the regression
analysis. These included: gender, age, length of stay at mealtime
observation date as a percentage of entire length of stay, main data
collector given that there was one main collector but others assisted, main
meal being observed, season, whether meal was stopped by patient,
presenting condition and medical history suggestive of poor appetite, and
whether patient’s diet code included thickened fluids, texture modification
or high-protein high-energy.
Aspects of protected mealtimes were investigated in Model 2 of the
regression analysis and included: meal within reach, mealtime assistance
required, mealtime assistance received, mealtime assistance documented
as being required, mealtime volunteers present on ward at time of
observation, appropriate positioning of patient during meal, time provided
to eat meal, whether the patient was interrupted during the meal and
whether the protected mealtimes program had been implemented on
the ward.
RESULTS
Overall, 798 patients had at least one mealtime observed, with
1499 mealtime observations being collected in total. Patient
demographics are displayed in Table 1.
Patient factors and aspects of protected mealtimes that were
associated with intake
Average mealtime intakes were 1419 ± 614 kJ and 15 ± 7 g protein
for all patients (n = 798, Table 1). Intakes were positively associated
with age, being male, a shorter length of time until discharge,
eating at dinner and eating in winter/autumn (Table 2). Intakes
were negatively associated with the patient stopping or refusing
their meal (B = − 829 to 222 kJ, B = − 8.8 to 2.2 g protein, P = 0.000–
0.032, R2 = 0.148–0.154). Intakes were not associated with mod-
ified diet code, main data collector or poor appetite (P = 0.110–
0.975).
Intake was not associated with the implementation of protected
mealtimes (P = 0.094–0.157; Table 2). Yet intakes were positively
associated with many aspects of protected mealtimes, including
not requiring mealtime assistance, mealtime assistance documen-
ted as being required, appropriate positioning during mealtime,
mealtime volunteers being present on ward during mealtimes and
having more time to eat (B = 177–296 kJ, B = 0.07–3.9 g protein,
P = 0.000–0.014). Intakes were not significantly associated with
meal being within reach, patients being interrupted and patients
receiving mealtime assistance (P = 0.103–0.800). Collinearity was
acceptable with tolerance ranging from 0.286 to 0.965 and
variance inflation factor from 1.036 to 3.494.
When all mealtime observations collected were analyzed
(n = 1499), two additional aspects of protected mealtimes were
significantly associated with energy and protein intakes. These
were meal within reach (B = 273 kJ, 95% confidence interval (CI)
126–420 kJ, P = 0.000; B = 2.5 g protein, 0.9–4.2 g, P = 0.003) and
patients being interrupted (B = − 121 kJ, − 202 to − 39 kJ, P = 0.004;
B = − 1.2 g protein, − 2.1 to − 0.3 g, P = 0.009, R2 = 0.129–0.136).
Collinearity was acceptable with tolerance ranging from 0.280 to
0.976 and variance inflation factor from 1.024 to 3.566.
© 2015 Macmillan Publishers Limited
 Protected mealtimes and patient intake
M Palmer and S Huxtable
963
Table 1. Patient demographic descriptors, mealtime observation information, and consumption during mealtimes before and after protected
mealtimes program implementation

TOTAL Pre-PMP implementation Post-PMP implementation P-value

n = 798, n = 348, n = 450,
n (%) n (%) n (%)

General descriptor
Gender, male 411 (52) 194 (56) 217 (48) 0.035
Age, years (mean ± s.d.) 63 ± 19 61 ± 19 64 ± 19 0.056
Meal stopped by patient, yes 10 (1) 4 (1) 6 (1) 1.000
Length of hospital stay, days (median (range)) 8 (0–168) 7 (1–154) 11 (0–168) 0.002
LOS at observation date as a percentage of entire LOS, % (mean ± s.d.) 62 ± 27 62 ± 26 60 ± 28 0.283
Season, autumn/winter 723 (91) 273 (78) 450 (100) 0.000
Presenting condition and medical history suggestive of poor appetite, yes 219 (28) 85 (24) 134 (30) 0.075
Hospital diet code included texture modification, thickened fluids, and/or 124 (16) 47 (14) 77 (17) 0.163
high protein high energy, yes

Strategies associated with protected mealtimes

Meal within reach, yes 729 (94) 319 (93)a 410 (96)b 0.090
Volunteers introduced to ward at time of audit, yes 257 (32) 0 (0) 257 (32) 0.000
Patient’s position was appropriate, yes 709 (94) 328 (95) 381 (93)c 0.437
Patient was interrupted, yes 184 (23) 44 (13) 140 (31) 0.000
Mealtime assistance required, yes 205 (26) 108 (31) 97 (22) 0.002
Mealtime assistance was received if required, yes 131 (64) 63 (58) 68 (70) 0.080
Mealtime assistance documented as being required, yes 117 (15) 57 (16) 60 (13) 0.233
Minutes provided to eat meal, (mean ± s.d.) 54 ± 11 52 ± 11 55 ± 11 0.002

Mealtime observed
Breakfast 281 (35) 98 (28) 183 (41) 0.001
Lunch 343 (43) 160 (46) 183 (41)
Dinner 174 (22) 90 (26) 84 (19)

Mealtime consumption
Energy intake, kJ (mean ± s.d.) 1419 ± 614 1433 ± 629 1407 ± 602 0.552
Protein intake, g (mean ± s.d.) 15 ± 7 15 ± 7 14 ± 7 0.641
Energy intake, Assistance required, kJ, (mean ± s.d.) 1340 ± 624 1323 ± 572 1359 ± 681 0.676
Protein intake, Assistance required, g, (mean ± s.d.) 14 ± 7 14 ± 6 14 ± 7 0.794
Abbreviations: LOS, length of stay; PMP, protected mealtimes program. an = 344. bn = 429. cn = 409. Bolded data were statistically significant (Po0.05).

Patient factors and aspects of protected mealtimes that were
associated with intake in those requiring mealtime assistance
Average mealtime intakes were 1340 ± 624 kJ and 14 ± 7 g protein
for those requiring mealtime assistance (Table 1). In those
requiring mealtime assistance (n = 189), energy intake was
positively associated with a shorter length of time until discharge
(B = 352 kJ, 95% CI 1–702 kJ, P = 0.049) and required mealtime
assistance being documented (B = 237 kJ, 95% CI 7–467 kJ,
P = 0.043), and negatively associated with meal being stopped
by patient (B = − 943 kJ, 95% CI − 1838 to − 47 kJ, P = 0.039,
R2 = 0.196). In the same group, protein intake was positively
associated with volunteers being introduced to wards at mealtime
observation (B = 4.4 g protein, 95% CI 0.9–7.8 g, P = 0.013) and
patient being appropriately positioned (B = 4.1 g protein, 95% CI
0.5–7.8 g, P = 0.026, R2 = 0.197). All other variables were not
significantly associated (P = 0.060–0.999). Collinearity was accep-
table with tolerance ranging from 0.233 to 0.897 and variance
inflation factor from 1.114 to 4.289.
Comparing patient and mealtime factors pre- and post
implementation of protected mealtimes
Patients observed prior to protected mealtimes implementation
had a shorter length of stay, more were male and less were
observed in autumn or winter (Table 1). More breakfasts were
observed in the post-implementation period (P = 0.001). All other
general or demographic descriptors were similar between pre-
and post implementation.
Patients observed prior to the implementation of protected
mealtimes were more likely to require mealtime assistance, had
less time to consume their meals and were less likely to be
interrupted (Table 1). Approximately one third (32%) of patients
audited in the post period had mealtime volunteers available on
their wards. Overall, 43% (n = 88/205) of patients requiring
mealtime assistance were not documented as requiring mealtime
assistance, with similar proportions observed pre- and post
implementation of protected mealtimes (pre: 47%, n = 51/108 vs
post: 38%, n = 37/97, P = 0.190).
DISCUSSION
The efficacy of protected mealtimes programs in improving
inpatient intakes has not yet been established. We showed that
the implementation of a protected mealtimes program was not
associated with inpatient intakes. Yet we found that many aspects
of protected mealtimes were associated with inpatient energy and
protein intakes. There are several likely explanations for our
findings.
First, efficacy of protected mealtimes implementation may not
be established if many aspects of protected mealtimes were
already in place prior to the implementation of the protected
mealtimes program. A high proportion (490%) of patients already
had their meals within reach, were appropriately positioned, and
many were being provided mealtime assistance if required. Some
of these aspects were positively associated with inpatient intakes,
yet already in place prior to protected mealtimes implementation.
Average time to eat prior to the protected mealtimes program
implementation (450 min) was also likely sufficient for the
majority of inpatients. Walton et al.15 reported that although
some elderly patients on a rehabilitation ward required up to

© 2015 Macmillan Publishers Limited European Journal of Clinical Nutrition (2015) 961 – 965
 Protected mealtimes and patient intake
M Palmer and S Huxtable
964
Table 2. Multivariate linear hierarchical regression analyses to determine factors associated with mealtime energy and protein intakes

Variable Mealtime energy intake (kJ) Mealtime protein intake (g)

(n = 728)a (n = 728)a

B 95% CI P-value B 95% CI P-value

2 2
Overall R ; R change from model 1 to 2; P-value 0.148; 0.074; 0.000 0.154; 0.088; 0.000

Model 1—patient factors

Gender, male 222 135 to 307 0.000 2.2 1.3 to 3.2 0.000
LOS at observation date as a percentage of entire LOS (%) 179 15 to 343 0.032 1.4 − 0.5 to 3.2 0.152
Winter/Autumn season, yes 131 41 to 221 0.004 1.6 0.6 to 2.7 0.002
Age (years) 3 0.6 to 6 0.016 0.02 − 0.01 to 0.05 0.105
Meal: dinner (vs lunch or breakfast) 74 − 37 to 184 0.193 1.9 0.6 to 3.1 0.004
Meal stopped by patient, yes − 829 − 1299 to − 360 0.001 − 8.8 − 14.2 to − 3.5 0.001
Main data collector, yes − 20 − 174 to 134 0.798 0.03 − 1.7 to 1.8 0.975
Presenting condition and medical history suggestive of poor appetite, yes − 80 − 181 to 20 0.206 − 0.9 − 2.1 to 0.2 0.110
Patient diet code included thickened fluids/ texture modification/high protein − 83 − 212 to 46 0.117 − 0.9 − 2.4 to 0.6 0.230
high energy, yes

Model 2—aspects of protected mealtimes

Implementation of protected mealtimes program, yes − 113 − 269 to 44 0.157 − 1.5 − 3.3 to 0.3 0.094
Mealtime assistance was documented as being required, yesb 296 115 to 478 0.001 3.1 1.0 to 5.1 0.004
Appropriately positioned, yes 292 102 to 483 0.003 3.9 1.7 to 6.1 0.000
Mealtime assistance required, no 236 59 to 413 0.009 2.5 0.5 to 4.6 0.014
Volunteers introduced to ward at time of audit, yes 177 49 to 304 0.007 2.9 1.4 to 4.4 0.000
Time provided to eat meal (minutes) 3 − 0.6 to 7 0.100 0.07 0.02 to 0.1 0.005
Mealtime assistance received, yes − 41 − 173 to 92 0.546 0.2 − 1.3 to 1.7 0.800
Interruptions, yes − 73 − 180 to 34 0.183 − 0.5 − 1.8 to 0.7 0.383
Meal within reach, yes 164 − 33 to 361 0.103 1.6 −0.7 to 3.8 0.164
Abbreviations: B, beta coefficient; CI, confidence interval; LOS, length of stay. aSample size included in the final analysis is smaller due to missing data in the
dependent variables. Bolded data were significantly associated with intake (Po 0.05). bPatients were documented as requiring mealtime assistance either via
the patient’s care plan in the bed chart (prior to implementation of protected mealtimes) or via Trendcare—the diet code management program (post
implementation).

55 min, average time taken to eat their meals was only 22.2 min.
Other published studies also suggest that many of these aspects
may already be in place prior to the implementation of a
protected mealtimes program. Rafferty et al.16 found that 475%
of meal trays were within reach on an oncology ward during
lunchtime audits. Hickson et al.7 found that 86% of patients were
already receiving mealtime assistance when required prior to the
protected mealtimes program implementation. These studies
demonstrate that baseline comparison data are important to
collect in order to determine the impact of the implementation of
a protected mealtimes program.
Second, a lack of compliance with some aspects of the
protected mealtimes program may explain why an association
between program implementation and intake was not observed.7
Our data showed that more interruptions occurred after the
implementation of protected mealtimes. As patient interruptions
were negatively associated with intake when all mealtime
observations were analyzed, this may explain why protected
mealtimes implementation was not associated with intake.
Other studies have shown that interruptions can be reduced
post implementation of protected mealtimes,9,10 or remained
unchanged.7 Some components of protected mealtimes did
improve after program implementation though. Time provided
to eat and the availability of mealtime volunteers significantly
improved post-implementation of protected mealtimes. Both
were positively associated with inpatient intakes suggesting that
the program was moderately successful in achieving its goals.
A systematic review by Green et al.17 in 2011 also found some
evidence that assistance from volunteers at mealtimes can
improve intake but that further research was needed. Our article
supports these findings. Young et al5 similarly found an increase in
mealtime assistance post implementation. Measuring compliance
with protected mealtimes approaches is an important part of
evaluating the efficacy of protected mealtimes programs.2,7
However, compliance with some components of our program
was not measured. We did not specifically assess whether tray
delivery by foodservice was appropriate, whether nursing staff
mealtimes were rostered away from patient’s mealtimes and if
medical imaging and the speech pathology modified barium
swallow services were scheduled away from mealtimes. Hickson
et al.7 measured compliance and showed that protected
mealtimes was not successfully implemented. However, Young
et al.5 successfully implemented the program but still only found
modest improvements in adequacy of intake. Greater attention to
developing and supporting implementation is needed in pro-
tected mealtimes research3 in order to establish its efficacy.
Finally, other factors that are likely associated with or explain
inpatient intakes were not measured in our study. This includes
consumption at the previous main and mid meals, individual daily
nutrient requirements,5 certain medical conditions including
infection, cancer, delerium and functional impairment18 and food
and menu issues including portion sizes too large, limited menu
choice and food quality and presentation.19 Approximately 85% of
the variation in inpatient intake data are yet to be explained.
Future studies should try to further explain what factors impact on
inpatient intakes. Additionally, ready reckoner averaged nutrient
data were used to convert portions consumed to nutrients. This
limits the information on the nutrient density of each of the
individual meals consumed. However, nutrient data were applied
consistently across the pre- and post-implementation periods, and
the menu only had minor changes during data collection. We
have also previously shown that the proportion of nutrient-dense
menu items consumed at main meals were similar pre- and post-
protected mealtimes implementation.6
Although studies have previously been unable to link the
implementation of protected mealtimes to improved inpatient

European Journal of Clinical Nutrition (2015) 961 – 965 © 2015 Macmillan Publishers Limited

intakes, we have found that patient intakes are significantly
associated with many aspects of protected mealtimes programs.
Our findings may assist in justifying the implementation of
protected mealtimes in acute care settings. During the planning
stage, exploring and identifying the achievable aspects of
protected mealtimes or favorable mealtime environments that
may assist with improving patient intakes is encouraged. However,
the challenge remains how to comprehensively implement and
successfully maintain this program.7 Ensuring compliance with
protected mealtimes implementation may be critical for optimiz-
ing acute inpatient intake.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
ACKNOWLEDGEMENTS
We would like to thank Queensland Health for the resources provided. No financial
support was received. Thanks to Patricia Lee for her helpful statistical consultations.
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