BackgroundIn the UK, life expectancy for people living with a serious mental illness, such as schizophrenia and bipolar disorder, is reduced by 15–20 years compared with the general population. In recent years, evidence based guidelines/policies designed to improve their physical health have been published, yet a gap remains between recommendations and practice. This case study describes how guidelines to support physical health were implemented using a quality improvement approach.Case presentationA quasi-experimental study explored systems and processes for assessing the physical health of patients admitted to an acute mental health unit. The multi-disciplinary team of healthcare professionals, service users and experts in quality improvement methods developed solutions to improve the assessment of physical health, drawing on existing guidelines/policies as well as professional and lived experience. Three key interventions were developed: a comprehensive physical health assessment; a patient-held physical health booklet; and education and training for staff and patients. Interventions were co-designed by front-line healthcare staff and service users with iterative development and implementation through Plan-Do-Study-Act cycles. Real-time weekly data were reported on five measures over a 15-month implementation period (318 patients) and compared to a 10-month baseline period (247 patients) to gauge the success of the implementation of the physical health assessment. Improvements were seen in the numbers of patients receiving a physical health assessment: 81.3% (201/247) vs 96.9% (308/318), recording of body mass index: 21.55% (53/247) vs 58.6% (204/318) and systolic blood pressure: 22.35% (55/247) vs 75.9% (239/318) but a reduction in the recording of smoking status: 80.1% (198/247) vs 70.9% (225/318). However, 31.7% (118/318) patients had a cardiovascular risk-score documented in the implementation phase, compared to none in the baseline.ConclusionThis study demonstrates the use of a quality improvement approach to support teams to implement guidelines on physical health in the acute mental health setting. Reflections of the team have identified the need for resources, training, support and leadership to support changes to the way care is delivered. Furthermore, collaborations between service users and frontline clinical staff can co-design interventions to support improvements and raise awareness of the physical health needs of this population.

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Background The ward round often represents the mainstay of doctor-patient contact during a hospital stay. They give the opportunity for the multi-disciplinary team to tailor individual patient care and improve patient safety and experience. In 2012 the Royal Colleges of Physicians and Nursing created a set of best practice principles for ward rounds. This audit aimed to compare current practice to these best practice principles. Methods A prospective audit of 45 inpatients on the Obstetric and Gynaecology wards of Walsall Manor Hospital in nine days of April 2013. Standards set out in the document “Ward Rounds in medicine – Principles for best Practice” were used as a benchmark. Results 89% (40/45) patients were reviewed by a doctor, 58% (23/40) of whom were reviewed before 10am, with 30% (12/40) being reviewed between 10:00 and 13:00. There was considerable variation between consultants as to the percentage of their patients which were reviewed (50–100%), the time of day at which the review took place and who reviewed the patient. Conclusions The majority of patients are probably being reviewed on most days of their hospital stay by a senior doctor. However there is considerable variation depending on the consultant responsible for the patients’ care. Reducing this variability may be important in improving patient experience and safety. By creating guidelines based on the best practice principles it may be possible to reduce variability and better involve members of the multidisciplinary team. It will also help define future audits and provide for meaningful national comparisons.