The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards

Ahmad, Aftab; Purewal, Tejpal; Sharma, Deepak; Weston, Philip J.

doi:10.7861/clinmedicine.11-6-524

Cited by 33 publications

(25 citation statements)

References 20 publications

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“…Ward rounds are an established process for clinical review and connecting clinicians with patients. Historically, the ward round was framed as a process through which medical staff, generally accompanied by nurses, attended the bedside of patients and made clinical decisions (Ahmad, Purewal, Sharma, & Weston, ; Nikendei, Kraus, Schrauth, Briem, & Junger, ). In many settings, this traditional form of rounding continues today.…”

Section: Introductionmentioning

confidence: 99%

Mapping trends in the concept of nurse rounding: A bibliometric analysis and research agenda

Hutchinson

Higson

Jackson

2017

Int J of Nursing Practice

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Section: Introductionmentioning

confidence: 99%

Mapping trends in the concept of nurse rounding: A bibliometric analysis and research agenda

Hutchinson

Higson

Jackson

2017

Int J of Nursing Practice

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“…5 One hospital has recently reported a reduction in average inpatient stay to 5.3 days, coincident with the introduction of twice-daily consultant ward rounds. 6 Nevertheless, demand frequently outstrips supply. Hospitals are often 'full' , with deleterious effects that include delayed patient flow, failure of specialty ward-based hospital systems and delayed or cancelled elective admissions.…”

Section: Introductionmentioning

confidence: 99%

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

Hendy¹,

Patel²,

Kordbacheh

et al. 2012

Clinical Medicine

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-Delayed patient discharge will likely exacerbate bed shortages. This study prospectively determined the frequency, causes and potential cost implications of delays for 83 consecutive patients, who were inpatients for a total of 888 days. 65% of patients experienced delay whilst awaiting a service. 48% of patients experienced delays that extended their discharge date. Discharge delays accounted for 21% of the cohort's inpatient stay, at an estimated cost of £565 per patient; 77% of these hold-ups resulted from delays in the provision of social and therapy requirements. Discharge delays are costly for hospitals and depressing for patients. Investment is required to enable health and social-care professionals to work more closely to improve the patient journey. KEY WORDS: delayed discharge, patient experience, patient journey, Quality, Innovation, Productivity and Prevention (QIPP) agenda IntroductionThe NHS is increasingly criticised for bed shortages, delayed elective admissions and long waiting lists. 1 The number of admissions to secondary care in the UK is growing year-on-year 2 because of limited out-of-hours services in primary care, a greater number of patients who expect proactive hospital care and, most significantly, an increasing population of older people. Older patients are often frail and have complex social and healthcare needs, resulting in a prolonged inpatient stay. 3 At the same time as hospital admissions have increased, there has been a decrease in the number of hospital inpatient beds. 4 This has been off-set by efficiency directives, with a reduction in the average inpatient stay from 11.7 days in 1980 to 6.8 days in 2000. 5 One hospital has recently reported a reduction in average inpatient stay to 5.3 days, coincident with the introduction of twice-daily consultant ward rounds. 6 Nevertheless, demand frequently outstrips supply. Hospitals are often 'full' , with deleterious effects that include delayed patient flow, failure of specialty ward-based hospital systems and delayed or cancelled elective admissions.Bed pressures are increased by 'delayed discharges' , which exacerbate patients' exposure to hospital-acquired infections, low mood and increasing loss of functional capacity. Remedying such delays would provide both cost savings and better quality of care, in line with the NHS Quality, Innovation, Productivity and Prevention (QIPP) agenda.The aims of this longitudinal prospective study were to determine the length of inappropriate delay experienced by patients in a general medical ward prior to discharge, to identify common causes of delay and to estimate the financial implications of discharge delays. MethodsThe Chelsea and Westminster Hospital, London, admits both medical and surgical patients to an acute admissions unit (AAU), from which 60% are discharged home within 48 hours. The remainder are transferred to base wards. The majority of these patients require specialist elderly care that cannot be provided by single organ specialists.For seven weeks beginning 12 October ...

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“…The presence of senior clinicians is essential for decisions to be made regarding discharges. A study found that average LoS was significantly improved by daily consultant supervision [40].…”

Section: Managing Length Of Staymentioning

confidence: 99%

Redesigning care for frail older people: The impact of an elderly care pathway on admission avoidance, length of stay and readmission rates

Nathaniel¹,

Amin²

2016

har

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Background: Increasing age predisposes elderly persons to long-term medical conditions, frailty, and geriatric syndromes such as pressure ulcers, falls, incontinence, delirium and functional decline. Increased hospital stays also have adverse effects on frail older people. Strategies are needed to ensure that elderly people are seen by the appropriate professionals to reduce adverse effects. This study aimed to assess the impact of an elderly care pathway in an emergency department ('front door') on admission avoidance, length of stay in hospital, and 30day readmission rate. Methods:In this single case study, quantitative data on frail elderly persons aged 75 years and over seen by the Acute Elderly Unit (n = 605; AEU group) were compared with those seen by a general medical team (n = 327; non-AEU group) at Barking Havering and Redbridge University Hospitals NHS Trust, UK, to calculate the average length of hospital stay and readmission rates. Members of the elderly care multidisciplinary team were also interviewed, and data analysed using thematic analysis. Results:Length of stay and admission prevention were higher in the AEU group than the non-AEU group. Conclusions:To facilitate quality care for frail older persons, an elderly care pathway is needed that includes early discharge planning, a person-centred approach, intensive multidisciplinary team involvement and joined-up working.Citation: Nathaniel Z, Amin K (2016). Redesigning care for frail older people: the impact of an elderly care pathway on admission avoidance, length of stay and readmission rates. Healthy Aging Research 5:14.

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The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards

Cited by 33 publications

References 20 publications

Mapping trends in the concept of nurse rounding: A bibliometric analysis and research agenda

Mapping trends in the concept of nurse rounding: A bibliometric analysis and research agenda

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

Redesigning care for frail older people: The impact of an elderly care pathway on admission avoidance, length of stay and readmission rates

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