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.

Keywords: PDSA; checklists; continuous quality improvement; hospital medicine; quality improvement.