Geriatric and Stroke Medicine


The Geriatric and Stroke Medicine (GSM) wards at Sheffield Teaching Hospitals include Brearley 5,6,7 and Robert Hadfield 5 and  6. They provide ongoing care for elderly patients with dementia and patients that have suffered a stroke.  The GSM wards established a microsystem project team. This is a multidisciplinary  team of staff, meeting on a weekly basis to look at improving the quality of care to patients. This Microsystem was part of a wider ward collaborative project.

Assessment and diagnosis

The Microsystem team started by doing an in depth 5p’s assessment. This is essentially a detailed health check of the wards and their current processes. The team spent 6-7 weeks looking at their purpose, patients, processes, patterns and professionals. The following issues were identified, E-discharge, ward noise, case notes and board rounds.  The Microsystem team established global and specific aims for each of these themes. This enabled the team to narrow their focus on each theme


The team used a fishbone diagram to identify the reasons for e-discharge delays. E-discharge is used to essentially inform the GP about the patients medication and history .  A new discharge checklist was introduced and reminders were also put up on the wards. E-discharge compliance improved from 37 hours to 11.

The team also used DeBono’s Six Thinking hats to look at improving board rounds. A new proforma was introduced to improve board rounds. This is still being used at board rounds.

The team worked together and the ward clerks stardardised patients medical and nursing notes across all the five wards. These are now in manageable folders.

The team have also looked at noise on the wards. Research claims that noise can “stress out” patients and diminish their chance of restful sleep (Nursing Times 2014). A quieter, more tranquil ward provides a more therapeutic environment for patients, staff and carers.

They piloted the use of a sound ear 2 © device on one of the wards. These are visual warning ears that light up when the ward gets too noisy. This ‘plan do study act’ showed an improvement in noise levels, particularly at night. Average decibel levels went down from 50 to 47 DB. A successful Essence of Care bid has enabled the team to purchase three of these devices. Three devices have now been implemented on the wards.

The ward team is continuing to meet on a weekly basis and are currently looking at other improvement themes including referrals to Occupational Therapists and Physios.



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