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Service designFeb 3, 2021

Report on revamping ward rounds reveals how patients in wheelchairs gained more control from changes

A decision by physiotherapists and other clinicians to modernise how they conducted ward rounds helped to improve patient confidentiality, according to a case study appearing in a report published by the Royal College of Physicians (RCP).

The case study, submitted by Norfolk Community Health and Care NHS Trust, is one of a number appearing in Modern ward rounds: Good practice for multidisciplinary inpatient review.

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A Royal College of Physicians report calls for ward rounds to be modernised

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The report, which includes templates, checklists and advice, aims to encourage clinical teams to assess their own practice and identify how they can make improvements. 

As well as input from the RCP, the Chartered Society of Physiotherapy, Royal College of Nursing, Royal Pharmaceutical Society and NHS England also contributed to developing the guidance.

'Shared bays' hampered confidentiality

In the example from the Norfolk trust, a multidisciplinary team on an amputee rehabilitation ward found patient confidentiality was constrained during ward rounds, which took place in shared bays.

In addition, older patients felt intimidated when surrounded by teams that could include a consultant, junior doctor, nurse, physiotherapist, occupational therapist and, at times, students.

A failure to iron out underlying problems leads to "frustration for staff and patients, and can lead to errors in care, longer stays in hospital and readmissions"[RCP report]

Giving patients 'more control'

The solution in Norfolk was to hold ward rounds in a dedicated room at which every team member could be seated – with patients being brought in for reviews and confidential discussions.

‘Patients felt more in control, as those in wheelchairs were able to leave when they wished,’ the case study notes.

Further, being able to bring a family member in with them gave patients opportunities to ask questions and reduced the need for separate family meetings, the case study adds.

An introduction to the publication on the RCP’s website suggests ward rounds are ‘consistently constrained by the competing priorities of clinical staff’, with problems including:

workforce gaps
inadequate planning
unwarranted variations in practice
an absence of training in the skills required to deliver complex multidisciplinary team care
A failure to iron out problems leads to 'frustration for staff and patients, and can lead to errors in care, longer stays in hospital and readmissions,’ it suggests.

Elsewhere, the report says that ward rounds be curtailed after a maximum of 150 minutes, in order to prevent ‘cognitive fatigue’. ‘If a longer round is necessary, then adequate breaks should be planned,’ it notes.

‘Team roles should be divided to ensure that tasks, such as ordering investigations or completing transfer documents, can be done during the ward round, and are not delayed until the end. This should be planned whenever possible. ‘

Key points for multidisciplinary teams:

agree principles, standards, functions and structure for local ward teamworking

clarify each team member’s role

include each tier of decision-makers as per the RCP’s Safe medical staffing See: https://www.rcplondon.ac.uk/projects/outputs/safe-medical-staffing

agree methods and times of communication

keep membership of the ward’s multidisciplinary team consistent wherever possible

ensure opportunities for team education and development.

regularly review team performance

The report calls on healthcare professionals to ensure patients have a clear understanding of the purpose of the ward round, when it is likely to take place and what is likely to happen.

‘Anyone identified by the patient as being important to them who is present at the time of the ward round should also be included in the conversation and communication.

‘Wards should have an explanatory leaflet to give to patients and those identified as being important to them that includes details of ward rounds.

‘Arrangements should be made for patients with translation needs of or other communication difficulties.' 

Education, training and learning: the way forward

In a section on education, training and learning, the report says everyone in the ward round should be involved in such initiatives.

‘Simulation of ward rounds should be used to train staff in important skills. Learning points should be summarised at the end of ward rounds with opportunities for further learning.

‘Patients should be informed that teaching and learning are part of ward rounds and consent requested when appropriate,’ it adds.

To access the report, visit: https://www.rcplondon.ac.uk/projects/outputs/modern-ward-rounds

Author: Ian A McMillan
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