Time to rethink the food chain for sustainable patient meals in hospitals: A scoping review

This scoping review examined sustainable food service interventions implemented in adult inpatient hospital settings across high-income countries. Using the Triple Bottom Line (TBL) framework, the review mapped sustainability practices across procurement, preparation, meal ordering, meal delivery, and waste management stages, and synthesised their social, economic, and environmental impacts. Out of 10309 articles screened, 36 met eligibility criteria. Across food service stages, sustainability interventions consistently improved patient experience, enhanced staff engagement, and strengthened organisational collaboration. Social benefits included increased patient satisfaction rising to nearly 98% with cook-hold systems and improved dietary intake through bedside electronic meal ordering systems and room-service models. Mealtime assistance reduced reliance on supplements, while food service dietitians improved communication and workflow. Economically, many interventions generated substantial cost savings despite few early investments. Rooftop farms reduced external purchasing costs, reduced meat procurement lowered ongoing food budgets, and advanced cooking systems decreased equipment, and operational costs by up to 81%. Electronic ordering systems reduced inappropriate meal delivery, and room-service models lowered labour and meal costs. Employment of food service dietitians produced system-wide savings. Waste management strategies, including composting and food repurposing reduced disposal and transport fees. Environmental outcomes were the most frequently reported, with large reductions in food waste, energy use, and emissions. Cooking innovations reduced electricity consumption by up to 93% and food waste by 85%, while room-service delivery and personalised menu decreased plate waste by up to 25%. Waste diversion and resource recovery further reduced landfill contributions and emissions. Sustainable hospital food service interventions deliver complementary social, economic, and environmental benefits. This review highlights substantial opportunities for health services to enhance sustainability, improve patient care, and reduce operational costs through integrated food service strategies. Further research addressing sustainability practices targeting food procurement and distribution stages are required to bridge the gap. • Sustainable food services improved patient satisfaction and dietary intake. • Cooking and delivery innovations reduced waste and energy use. • Meal ordering technologies enhanced oral intake and reduced inappropriate meal delivery. • Waste diversion and food repurposing lowered emissions and landfill impacts.