Ward rounds are often undervalued, considering that they represent the patient and medical team interface. Ward rounds give us the opportunity to excel in our management plans in order to move the patient’s care forward. However ordinary ward rounds might be regarded, they involve highly complex decision making and require the utilisation of extremely skilful communication skills. Nonetheless, there are certain issues that are frequently experienced which impact the efficiency of the ward rounds with the potential to influence patient safety:
Common issues encountered during ward rounds
Medical team
- Interruptions by the bleep/pager influencing the clinical examinations and decision making.
- Registrars being asked to leave the ward round if they are on -call to focus on other acute medical/ surgical duties.
- Consultants running late due to delays in clinic or in theatres and thereby starting the ward rounds late in the afternoon which will impact the time that is left for junior doctors to carry out post round jobs.
- Charge nurse and nurse at bedside not present to inform the medical team of issues that occurred overnight.
- Patients on outlier wards will usually be seen last on the ward round.
Patient notes
- Illegible handwriting in patient notes, loose documents in the patient’s folder in need of filing.
- Not sufficient number of computers, which at times require re-booting several times. This is time consuming and uses valuable time where patients could have been seen by the medical team.
- Patient information being presented on different software, such as; blood results, radiology investigations, ECHO’s and clinic letter notes. It can be a slow process to collate all the necessary information during the ward round.
- Different medical team members often require access to patient notes at the same time. This can be challenging due to a lack of electronic records.
- No access to GPs records with important information such as co-morbidities and medication list, junior doctors are usually asked to chase this up.
- The full medical team may not be present during the ward round leading to repeat conversations.
- Finding out if a test has been requested, by calling the laboratory.
A ward round that is structured and well conducted will result in a reduction in delirium and falls, reduce the incidents of DVTs/PEs, have fewer hospital acquired infections, prevention of pressure sores, fewer readmissions and have more timely discharges [1].
References:
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Caldwell G (2009). The Importance of Ward Rounds. Western Sussex Hospitals NHS Foundation Trust.
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