scholarly journals Improving communication on medical ward rounds with patients who speak limited English with implementation of medical communication charts

2021 ◽  
Vol 10 (3) ◽  
pp. e001389
Author(s):  
Amrita Naomi D'Souza ◽  
Ana Canoso ◽  
Laura-Jane Smith
Keyword(s):  
Healthcare Delivery ◽  
Physical Symptoms ◽  
Ward Round ◽  
Medical Ward ◽  
Language Therapy ◽  
College Hospital ◽  
Medical Communication ◽  
Face To Face ◽  
High Satisfaction ◽  
Ward Rounds

AimTo improve communication on the medical ward round with patients with limited English through implementation of a medical communication chart.Local problemKing’s College Hospital (KCH), London, is situated in Southwark in which 11% of households have no members that speak English as a first language, 4.1% of London’s population report they do not speak English well. Language barriers impair healthcare delivery including during daily ward rounds. This has been exacerbated by the need for PPE during the SARS-CoV2 pandemic. Effective communication between healthcare teams and patients is essential for high quality, patient-centred care. Communication tools commonly used include online, telephone and face-to-face translation services but these have limitations.MethodsFace-to-face patient questionnaires were conducted in the pre-QIP (baseline) group to assess communication on medical ward rounds. Medical communication charts were designed by adapting pre-existing aids commonly used by speech and language therapy. Charts were translated into commonly spoken languages among KCH inpatients. Patients with limited English were selected from both COVID-19 and non-Covid wards. Preintervention and postintervention questionnaires were completed in three Plan–Do–Study–Act (PDSA) cycles.ResultsAt baseline, patients agreed or strongly agreed that the ward round addressed physical symptoms (8/8), concerns or anxieties (7/8), ongoing needs (7/8). Only two of eight doctors felt they could communicate effectively with patients. In PDSA 1, four of five patients reported high satisfaction in communicating physical symptoms, anxieties or concerns preintervention with five of five postchart implementation. Five of five patients reported high satisfaction in communicating ongoing needs preintervention but only three of five postintervention. In PDSA 2, two of five patients reported increased satisfaction in communicating physical symptoms, concerns or anxieties with four of four doctors reporting improved satisfaction in communication in PDSA 2 and two of three doctors reporting higher satisfaction in communication in PDSA 3.ConclusionUsing communication charts in patients with limited English can improve bidirectional communication on medical ward rounds.

scholarly journals A Model for an Educational Virtual Ward Round

2021 ◽  
Author(s):  
Sarah Pauline Bowers ◽  
Philip J Dickson ◽  
Katharine Thompson
Keyword(s):  
Palliative Care ◽  
Medical Education ◽  
Medical Students ◽  
Healthcare Delivery ◽  
Ward Round ◽  
Clinical Placements ◽  
Care Teaching ◽  
Use Of Technology ◽  
Ward Rounds ◽  
Survey Responses

Abstract Background COVID-19 led to global disruption of both healthcare delivery and undergraduate medical education with suspension of clinical placements in alignment with government and university guidelines. To facilitate ongoing palliative care education, we aimed to develop a model for delivering virtual palliative care teaching and to assess the suitability of this as an alternative to in-person teaching. Method Basic technology (iPad and linked computer) were used to facilitate video conferencing, via the secure platform Microsoft Teams, between a consultant-led ward round in a specialist palliative care unit and fourth year medical students located in the education department of the unit. This was evaluated using electronic survey responses from patients, medical students and medical staff with generation of quantitative and qualitative data.Results Medical students greatly appreciated the opportunity to maintain attendance at clinical sessions during COVID-19. Quantitative and qualitative feedback demonstrated that the virtual ward round model effectively met medical students’ educational needs, particularly in relation to holistic assessment, pain management and communication skills. Only minor technological difficulties were noted. Feedback indicated that the use of technology to allow medical education was acceptable to patients, who were open and willing to adapt. Patients acknowledged that without medical students’ physical presence on ward rounds, there was an element of discretion; clinicians also found this to be beneficial. Conclusion COVID-19 has forced changes in the delivery of medical education. Virtual ward rounds are an effective method for delivering high quality palliative care teaching and are acceptable to patients, medical students and clinicians alike. Additional benefits beyond COVID-19 included allowing students to be present discretely during sensitive conversations whilst still meeting their learning outcomes.

scholarly journals Visual mapping of team dynamics and communication patterns on surgical ward rounds: an ethnographic study

2021 ◽  
pp. bmjqs-2020-012372
Author(s):  
Candice Bonaconsa ◽  
Oluchi Mbamalu ◽  
Marc Mendelson ◽  
Adam Boutall ◽  
Claire Warden ◽  
...  
Keyword(s):  
Decision Making ◽  
Leadership Styles ◽  
Healthcare Professionals ◽  
Ward Round ◽  
Communication Patterns ◽  
Team Dynamics ◽  
Face To Face ◽  
Infection Management ◽  
Visual Mapping ◽  
Ward Rounds

BackgroundThe effect of team dynamics on infection management and antimicrobial stewardship (AMS) behaviours is not well understood. Using innovative visual mapping, alongside traditional qualitative methods, we studied how surgical team dynamics and communication patterns influence infection-related decision making.Materials/methodsBetween May and November 2019, data were gathered through direct observations of ward rounds and face-to-face interviews with ward round participants in three high infection risk surgical specialties at a tertiary hospital in South Africa. Sociograms, a visual mapping method, mapped content and flow of communication and the social links between participants. Data were analysed using a grounded theory approach.ResultsData were gathered from 70 hours of ward round observations, including 1024 individual patient discussions, 60 sociograms and face-to-face interviews with 61 healthcare professionals. AMS and infection-related discussions on ward rounds vary across specialties and are affected by the content and structure of the clinical update provided, consultant leadership styles and competing priorities at the bedside. Registrars and consultants dominate the discussions, limiting the input of other team members with recognised roles in AMS and infection management. Team hierarchies also manifest where staff position themselves, and this influences their contribution to active participation in patient care. Leadership styles affect ward-round dynamics, determining whether nurses and patients are actively engaged in discussions on infection management and antibiotic therapy and whether actions are assigned to identified persons.ConclusionsThe surgical bedside ward round remains a medium of communication between registrars and consultants, with little interaction with the patient or other healthcare professionals. A team-focused and inclusive approach could result in more effective decision making about infection management and AMS.

Ward rounds, participants, roles and perceptions: literature review

2016 ◽  
Vol 29 (4) ◽  
pp. 364-379 ◽  
Author(s):  
Victoria Walton ◽  
Anne Hogden ◽  
Julie Johnson ◽  
David Greenfield
Keyword(s):  
Literature Review ◽  
Patient Involvement ◽  
Ward Round ◽  
Content Type ◽  
Team Members ◽  
Face To Face ◽  
Multidisciplinary Rounds ◽  
Ward Rounds ◽  
Medical Wards ◽  
Practical Implications

Purpose – The purpose of this paper is to classify and describe the purpose of ward rounds, who attends each round and their role, and participants’ perception of each other’s role during the respective ward rounds. Design/methodology/approach – A literature review of face-to-face ward rounds in medical wards was conducted. Peer reviewed journals and government publications published between 2000 and 2014 were searched. Articles were classified according to the type of round described in the study. Purposes were identified using keywords in the description of why the round was carried out. Descriptions of tasks and interactions with team members defined participant roles. Findings – Eight round classifications were identified. The most common were the generalised ward; multidisciplinary; and consultant rounds. Multidisciplinary rounds were the most collaborative round. Medical officers were the most likely discipline to attend any round. There was limited reference to allied health clinicians and patient involvement on rounds. Perceptions attendees held of each other reiterated the need to continue to investigate teamwork. Practical implications – A collaborative approach to care planning can occur by ensuring clinicians and patients are aware of different ward round processes and their role in them. Originality/value – Analysis fulfils a gap in the literature by identifying and analysing the different ward rounds being undertaken in acute medical wards. It identifies the complexities in the long established routine hospital processes of the ward round.

scholarly journals No substitute for experience: do consultants that have been practising for longer lead faster post-take medical ward rounds?

2013 ◽  
Vol 12 (3) ◽  
pp. 141-145
Author(s):  
Dipender Gill ◽  
◽  
Robert Gaunt ◽  
Shahir Hamdulay ◽  
◽  
...  
Keyword(s):  
Multivariate Regression ◽  
District General Hospital ◽  
Multivariate Regression Analysis ◽  
Ward Round ◽  
Medical Ward ◽  
Single Centre ◽  
North West ◽  
The North ◽  
Number Of Patients ◽  
Ward Rounds

Aim: To ascertain whether consultants that have been practising for longer lead faster post-take medical ward rounds. Method: Single-centre observational study of nine consultant physicians at morning post-take medical ward rounds at a district general hospital in the North West of London. Results: Data were gathered from 25 post-take medical ward rounds. Multivariate regression analysis revealed that less time is spent per patient when consultants have been practising for longer (p<0.01), or have spent more time on the specialist register (p<0.01), with no discernible relation to the outcomes for the patients seen. This time is further reduced when a greater number of patients are seen on the ward round. Conclusion: More experienced consultant physicians conduct faster post-take medical ward rounds.

scholarly journals Telemedicine use in orthopaedics: Experience during the COVID-19 pandemic

2021 ◽  
pp. 1357633X2110410
Author(s):  
Brian Z Chin ◽  
Nazrul Nashi ◽  
Shuxun Lin ◽  
Kevin Yik ◽  
Gamaliel Tan ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Healthcare Delivery ◽  
Outpatient Setting ◽  
Face To Face ◽  
Roles And Responsibilities ◽  
Orthopaedic Patients ◽  
High Satisfaction ◽  
Single Centre Experience ◽  
Satisfaction Rates

Introduction With a recent resurgence of the 2019 coronavirus disease (COVID-19) cases globally, an increasing number of healthcare systems are adopting telemedicine as an alternative method of healthcare delivery in a bid to decrease disease transmission. Continued care of orthopaedic patients in the outpatient setting during the coronavirus disease of 2019 era can prove challenging without a systematic workflow, adequate logistics, and careful patient selection for teleconsultation. The aim of this paper is to describe our single-centre experience with the application of telemedicine in our orthopaedic practice, and its effectiveness in maintaining outpatient follow-up of orthopaedic patients. Methodology We describe our centre's telemedicine model of care for orthopaedic patients on the outpatient follow-up – which includes workforce assembly, population health and target patients, logistics and communications, and overall workflow – with roles and responsibilities of involved people portrayed in detail. Results Feedback from both patients and orthopaedic surgeons reflected high satisfaction rates with care provided, noting minimal communication and clinical barriers compared to face-to-face consultations. Whilst not without limitations, our protocol allowed for rapid adoption of telemedicine in line with a national-wide initiative to digitize healthcare. Discussion The implementation of teleconsultation services at our orthopaedic centre has provided an effective method of healthcare delivery while enforcing social distancing measures – which proves vital in combating the spread of COVID-19 and ushering in a new normal.

EP.TU.571Is the pen mightier than the scalpel? Improving the quality and efficiency of Major Trauma ward rounds

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ethlinn Patton ◽  
Dapo Olaleye ◽  
Stella Smith
Keyword(s):  
Adverse Events ◽  
Major Trauma ◽  
Current Practice ◽  
Oral Intake ◽  
Cost Effective ◽  
Poor Quality ◽  
Ward Round ◽  
Before And After ◽  
Ward Rounds ◽  
Gathering Data

Abstract Aims Methods Data was collected retrospectively between October to December 2020. Patient paper notes were reviewed on three dates before and after implementation of the ward round sticker, gathering data from 26 and 27 patients respectively. Data was collected across a series of weeks to ensure a variety of clinicians present on ward round, in order to accurately reflect current practice. Results An improvement in rate of documentation was seen in 10 out of 12 key clinical variables. Some of the largest increases were seen in consideration of VTE status; 96.3% (n = 26) from 7.69% (n = 2), and recording oral intake; 85.2% (n = 23) from 23.1% (n = 6.) Conclusions We know that poor quality documentation is associated with increased rates of adverse events for patients,[1] so it is imperative to address both what is being covered, and how it is being recorded. Staff reported that the use of ward round stickers improved legibility of documentation and made it easier to locate important information. This simple, cost effective intervention has improved the consistency of daily reviews, and streamlined communication within the multidisciplinary team.

SP2.1.5Does the introduction of ward round stickers improve surgical ward rounds?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Vivek Sharma ◽  
Emma Fitz-patrick ◽  
Dhiraj Sharma
Keyword(s):  
Quality Improvement ◽  
Good Practice ◽  
Ward Round ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Vte Prophylaxis ◽  
Baseline Performance ◽  
Surgical Ward ◽  
Ward Rounds ◽  
Surgical Teams

Abstract Aims With surgical teams in the NHS pushed to their limit under unprecedented demands, simple and effective ways for maintaining standards of patient care are necessitated. This quality improvement project aims to implement user-friendly and coherent ward round stickers as an adjunct to surgical ward rounds to deliver standardised care. Methods Baseline performance was measured against The Royal College of Surgeons of Edinburgh Surgical Ward Round Toolkit. Five recorded items were studied including: bloods, venous thromboembolism (VTE) prophylaxis, regular medications, observations, and handover to nursing staff. The surgical team was informed of the audit but not over which dates it would be conducted. In the first cycle, data was collected over a 4 week period. Ward round stickers were then implemented and a second cycle was completed 2 months later over another 4 week period. Results Baseline performance recorded from 74 ward round entries showed checking of bloods, VTE, regular medications, observations and handover ranged from 0% to 65%. After the introduction of ward round stickers, a second cycle was performed from 81 ward round entities. There was significant improvement from baseline with compliance in recording all five items &gt; 85%. Conclusion This quality improvement project showed that the use of stickers as an adjunct to surgical ward round is a simple and effective way of evidencing good practice against recommended standards.

scholarly journals Impact of COVID-19 on cancer service delivery: results from an international survey of oncology clinicians

ESMO Open ◽  
2020 ◽  
Vol 5 (6) ◽  
pp. e001090
Author(s):  
Grace Chazan ◽  
Fanny Franchini ◽  
Marliese Alexander ◽  
Susana Banerjee ◽  
Linda Mileshkin ◽  
...  
Keyword(s):  
Service Delivery ◽  
Patient Survival ◽  
Objective Assessment ◽  
Healthcare Delivery ◽  
Policy Implications ◽  
Clinical Practices ◽  
Cancer Service ◽  
Face To Face ◽  
Community Transmission ◽  
Negative Impacts

ObjectivesTo report clinician-perceived changes to cancer service delivery in response to COVID-19.DesignMultidisciplinary Australasian cancer clinician survey in collaboration with the European Society of Medical Oncology.SettingBetween May and June 2020 clinicians from 70 countries were surveyed; majority from Europe (n=196; 39%) with 1846 COVID-19 cases per million people, Australia (AUS)/New Zealand (NZ) (n=188; 38%) with 267/236 per million and Asia (n=75; 15%) with 121 per million at time of survey distribution.ParticipantsMedical oncologists (n=372; 74%), radiation oncologists (n=91; 18%) and surgical oncologists (n=38; 8%).ResultsEighty-nine per cent of clinicians reported altering clinical practices; more commonly among those with versus without patients diagnosed with COVID-19 (n=142; 93% vs n=225; 86%, p=0.03) but regardless of community transmission levels (p=0.26). More European clinicians (n=111; 66.1%) had treated patients diagnosed with COVID-19 compared with Asia (n=20; 27.8%) and AUS/NZ (n=8; 4.8%), p<0.001. Many clinicians (n=307; 71.4%) reported concerns that reduced access to standard treatments during the pandemic would negatively impact patient survival. The reported proportion of consultations using telehealth increased by 7.7-fold, with 25.1% (n=108) of clinicians concerned that patient survival would be worse due to this increase. Clinicians reviewed a median of 10 fewer outpatients/week (including non-face to face) compared with prior to the pandemic, translating to 5010 fewer specialist oncology visits per week among the surveyed group. Mental health was negatively impacted for 52.6% (n=190) of clinicians.ConclusionClinicians reported widespread changes to oncology services, in regions of both high and low COVID-19 case numbers. Clinician concerns of potential negative impacts on patient outcomes warrant objective assessment, with system and policy implications for healthcare delivery at large.

scholarly journals Development and implementation of a structured ward round in acute adult psychiatry

2018 ◽  
Vol 7 (3) ◽  
pp. e000035 ◽  
Author(s):  
Anna Rebecca Mattinson ◽  
Sarah Jane Cheeseman
Keyword(s):  
Improve Patient Safety ◽  
Quality Care ◽  
General Medicine ◽  
Multidisciplinary Care ◽  
Ward Round ◽  
Care Plan ◽  
Care Plans ◽  
Adult Psychiatry ◽  
Paired Male ◽  
Ward Rounds

Delivering high quality care in acute psychiatry requires a coordinated approach from a multidisciplinary team (MDT). Weekly ward rounds are an important forum for reviewing a patient’s progress and developing a personalised care plan for the coming week. In general medicine, structured ward rounds and check lists have been shown to prevent omissions and improve patient safety; however, they are not widely used in psychiatry. At the Royal Edinburgh Hospital, the format of ward rounds differed between psychiatry wards and clinical teams, and care plans were not standardised. An audit in October 2015 found only 5% of acute psychiatric inpatients had a documented nursing care plan. It was agreed that a clear multidisciplinary care plan from the weekly ward round would be beneficial. A group of consultant psychiatrists identified seven key domains for ward round (Social needs, Community Mental Health Team liaison, Assessments required, Mental Health Act, Prescriptions: medication electroconvulsive therapy (ECT), T2/T3, Engagement with relatives and carers, Risk Assessment and Pass Plans). This was given the acronym SCAMPER. Following this, a clinical MDT on a paired male and female ward, developed and introduced a structured ward round sheet. Within 8 weeks this was being used for 100% of patients. It was subsequently introduced into three other acute adult psychiatry wards and the intensive psychiatric care unit. Staff feedback was sought verbally and via a questionnaire. This was positive. The form was widely accepted and staff felt it improved patient care and ward round quality.

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