Osborn 3 - Ward Rounds

Background

The Princess Royal Spinal Injuries Centre is a unit based at Sheffield Teaching Hospitals NHS FT, providing comprehensive Spinal Cord Injuries services for patients, with facilities for acute, rehabilitation and continuing care. The centre is a 60 bedded unit (equipped to support 6 ventilated patients) across 3 wards.

We have been meeting as a team, having weekly hour long meetings since June 2015, using a structured approach to improvement using the Microsystems improvement methodologies.  We have now completed our first phase of testing, aiming to improve the structure of our ward rounds.

Our ward rounds are a little different; we meet away from the ward as an MDT. There are two parts to the meetings; the first part is spent discussing the patients with the MDT reviewing progress over the last week and plans for the following week. The second part has the patients attending the meeting and discussing the plans, as well as an opportunity to ask questions about their care.

Assessment

We used the weekly meetings to carry out an assessment of all aspects of the ward (microsystem) as a whole. As a result of this, team working and communication were clearly themes that the team wanted to improve. From this the weekly ward rounds were chosen as an area for specific improvement and a detailed process map of the current process was carried out.

From the process map a number of areas for improvement were highlighted;

  • Meetings not starting on time
  • Meetings over running well past the 2 hours allocated time
  • Not all MDT members recording feedback
  • Difficulties around disseminating information gathered/discussed in the ward round meeting
  • Not having a clear set of actions from the discussion
  • Not fully understanding/appreciating other professional roles

 

Diagnosis

To fully diagnose the problems it was agreed to collect data on a number of different items;

  • Length of time discussions took with patients in ward round (face to face and non-face to face).
  • Number of patients who have clear set of actions agreed during the MDT
  • Length of time it takes to disseminate outcomes of MDT to nurses caring for these patients on the ward

 

Using the process map and the data collected clear objectives for the ward round were agreed by the team. The information coming out of the ward round must be;

  • Concise
  • Up to date
  • Easily accessible

 

Treatment

The team agreed that they wanted the ward round to be more structured, completed within agreed timescales and for each patient to have clearly recorded outcome.

To achieve this the following changes were tested;

  • For each patient the team would spend 5 minutes discussing the patients, 5 minutes meeting with the patient and 2 minutes recording clear outcomes and actions from the discussion. A leader and timekeeper are assigned at the beginning of each meeting to ensure this is monitored throughout the meeting.
  • From this it was now possible to give patients timed slots rather than waiting in a queue to be seen.
  • Each team member would have a clear set of updates about each patient that they would bring to the meeting. These are based around profession specific key aspects affecting patient care. These are displayed in the ward round room so all professions understand each other’s roles and responsibilities. This enables more concise and systematic feedback.
  • More concise electronic recording of the ward round discussion.
  • Patient leaflet outlining the purpose and structure of the ward round to assist patients in their understanding of what they can expect from the MDT and how they can contribute.

 

What we achieved

  • 100% of patients who have clear set of actions agreed during the MDT.
  • 30% increase in number of patients that are discussed, seen, and have agreed actions within 12 minutes per patient.
  • Significant decrease in time spent to disseminate outcomes of MDT to nurses caring for these patients on the ward

 

“Ward round is now a lot quicker and more efficient than it used to be, which means I can spend more time treating patients”

Next Steps

The team continue to meet to discuss and monitor their ward rounds, they plan to redesign the current ward round electronic template to further decrease the amount of time it takes to record outcomes and action and the time to disseminate this nursing staff. They also hope to spread these improvements to other ward rounds within the unit.

 

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