We have now completed our first phase of testing, aiming to improve the structure of ward rounds.
Assessment We used the weekly meetings to carry out an assessment of all aspects of the ward (microsystem) as a whole. Weekly ward rounds were chosen as an area for specific improvement. A process map of the current process was completed.
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
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.
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.
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 actions from the discussion.
A leader and timekeeper are assigned at the beginning of each meeting to ensure this is monitored.
Patients are given timed slots rather than waiting in a queue to be seen.
Each team member updates about each patient that they would bring to the meeting. These are based around profession specific key aspects affecting patient care. 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 increase 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”