New take on the post-take ward round: a quality improvement project undertaken in a district general hospital

Abstract

A patient’s first encounter with a consultant clinician, known as the post-take ward round (PTWR), is a pivotal encounter at the start of their hospital journey. It is a chance for a review of history, examination and investigations, formulation of preliminary diagnosis and management plan. High-quality patient care is reliant on effective communication of clinical information between teams, and the PTWR record is an integral part of this handover of information across different clinicians, medical teams and wards.Consensus of consultant opinion allowed for the formation of a standard against which the quality of PTWR documentation could be measured. This project aimed to assess and improve compliance with the devised standard.Following a survey of referrals made to the medical team after the move to electronic record keeping, it was found that important information was being missed from PTWR records. For example, of the 446 records analysed, only 34% had a documented potential discharge date (PDD) and 20% had a documented escalation plan. Analysis showed overall compliance to core criteria was 63%.Several changes within the department of acute medicine were trialled, including the introduction of a checklist, prompt cards for clinical staff to carry and finally the implementation of an electronic form for PTWR records.Over the course of several cycles of data collection, compliance with core criteria improved from 63% to 86%. Most notably, improvement was seen in documentation of social history (42%–87%), frailty score (0%–63%), PDD (41%–81%) and escalation plan (21%–66%).This work demonstrates the value of development of a standard for PTWR documentation, and of a proforma. The actions taken in this hospital may be of benefit to other medical departments.

A Standardized Ward Round Proforma Improves Documentation in a Specialist Stroke Unit

“…The consensus documentation criteria generated in this QI project are broadly similar to those employed in similar studies, including observations, examination findings, and diagnosis [ 4 , 6 , 7 ]. Some criteria are more specific to stroke patients, including documentation of mechanical VTE prophylaxis use, hydration status, and nutrition status.…”

“…At least 39 MDT members were invited to complete the anonymous online survey. A total of 11, 28.2% of those invited, responded, including senior medical staff (2), junior medical staff (7), and nursing staff (2). All respondents were aware of the new ward round proforma and the majority felt it was either very easy (54.5%) or easy (27.3%) to find in the patient notes.…”

“…Similarly, multiple studies have demonstrated improvement in documentation, when measured against set criteria, following the introduction of a proforma for medical post-take ward rounds [ 5 - 7 ]. Other reported benefits of ward-round checklists in medical settings include a reduction in the time spent in documentation by junior medical staff [ 8 ] and an increase in the initiation of comprehensive geriatric assessment following admission [ 9 ].…”