How to help ER surgical patients recover better? An Anchorage clinic tries gifts of food.

For a few months, a front-line trauma surgery clinic in Anchorage has been asking patients if they're worried about where their next meal is coming from.

If the answer is "yes," the clinic — where surgeons are on call to treat gunshot wounds, car crash victims and other serious injuries that come to the emergency room at Providence Alaska Medical Center — has a response. Since July, the staff at Alaska Trauma and Acute Care Surgery has been offering patients boxes of food. It's enough to last a family of four for three days.

It's an experiment with the Food Bank of Alaska that the surgeons suspect will lead to reduced hospital readmission rates, fewer infections and better recovery among patients.

"We get patients on their very worst day. They're traumatized, they come here, and they don't have food," said Cinderella Tollefsen, the chief executive of Alaska Health Services, the clinic's parent company. "To walk out with food gives them hope."

The boxes contain food that's easy to store and prepare, Tollefsen said. On a recent weekday, Tollefsen and the clinical manager, Heidi Unger, showed the contents of one. There were Pilot Bread crackers, jars of peanut butter and jelly, soup, fruits and vegetables in cans, a box of macaroni and cheese, chocolate milk and packets of Quaker oatmeal.

Research shows close ties between poverty, nutrition and health, said Jeffrey Sedlack, a general surgeon and the president of Alaska Trauma and Acute Care Surgery, who spearheaded the idea for the food boxes. He said a low-income patient who can't afford to eat is less healthy overall and more likely to develop an infection after leaving the hospital that forces them to return. Many of the patients are also dealing with other problems related to poverty, addiction, mental health and homelessness.

Repeat trips are very expensive for the health care system, while also causing more stress and a tougher recovery for the patient, Sedlack said. If a patient can't afford to pay the bill, the clinic writes off the cost, or it's billed to Medicaid.

Sedlack first came to Alaska as a member of the Navy and has been working with Providence for about a decade, traveling back and forth from his home in Maine. His two children are both public school teachers in Maine. He was troubled by their stories of the number of children who came to school without enough to eat. It got him thinking about food, and also nutrition and health, he said.

In Alaska, more than 20 percent of children are at risk of going hungry, and 5 percent are severely so, Sedlack said. Seniors, too, are at a higher risk for food insecurity.

As Sedlack started attending conferences on the role of food in medicine, he learned about anecdotal evidence pointing to the link between hunger and health care results.

"To have patients not return to the operating room, not have poor health outcomes, not have infections — all these things are associated with not eating," Sedlack said in a recent Skype interview from his home in Maine.

Sedlack has seen data supporting the idea of helping patients gain access to food. One health care journal recently highlighted efforts by a Maine agency to create a specialized food delivery service for people who had just been discharged from the hospital. The study found that hospital readmission rates for those patients declined 16 percent, Sedlack said.

He decided his clinic should test the idea. For the past several months, Sedlack and the clinic's managers have been working with the Food Bank of Alaska to set up a "food insecurity" screening process for patients.

The clinical manager asks questions authorized by the American Academy of Pediatrics. The first question is, "Within the past 12 months, we worried whether our food would run out before we got money to buy more." The second is, "Within the past 12 months, the food we bought just didn't last and we didn't have money to get more."

The possible answers include "often true," "sometimes true," "never true" or "don't know."

Soon enough, Sedlack, Tollefsen and Unger realized that when the answer to both questions is "yes," the clinic didn't have an immediate way to respond. Alaska has a strong safety net for hunger, but it can take up to about six weeks to get a person signed up for a consistent intervention, like food stamps, Sedlack said. That time delay doesn't help a surgical patient who is in crisis, Sedlack said.

At the same time, some patients don't qualify for food stamps but are suddenly unable to afford food because a traumatic medical situation kept them from working, Tollefsen said.

"A lot of people are one paycheck away from poverty," Tollefsen said.

From there, the team came up with an idea: transforming the clinic into a "micropantry." They wanted to be able to give out boxes of food for patients who didn't know where their next meal was coming from. They decided the box had to be small enough so a patient could carry it out. But it had to be big enough to hold enough food for a family for a few days.

The Food Bank picked out a selection of food that was easy to store and prepare. Alaska Trauma and Acute Care Surgery paid for everything. Then Unger enlisted the help of a few friends. It took just an hour at the Food Bank to piece the boxes together.

In all, it cost $900 to build 50 boxes of food that would feed a family of four for three days. In three months, the practice has handed out 10 boxes to different patients.

Unger said the response has been even better than she imagined.

"The ones we've given food boxes to have been incredibly grateful," Unger said.

There's been a lot of interest within the surgical community in the program, Tollefsen said. She said Alaska Trauma and Acute Care Surgery hopes to build up enough data and metrics to show that it's effective. In the future, the program could be expanded to other clinics or to the main downstairs area of the hospital, Tollefsen said.

"We're a small denominator, so it will be a while before we have significant data as to whether it reduces wound infections," Sedlack said.

"On the upside, it's the right thing to do."

Correction: An earlier version of this story incorrectly identified the chief executive of Alaska Health Services as Heidi Tollefsen. Her name is Cinderella Tollefsen. Also, Heidi Unger's title is clinical manager, not clinic manager.