No abstract

Introduction Medical 'ward round' (WR) is a complex clinical process and a key component of daily hospital activity. Despite this, there is a clear paucity of quality indicators and evidence base for best practice for WR with considerable variability in the efficiency and quality.This prompted us to devise and implement a ward round checklist (WRC)based on the Royal College of Physicians (RCP) and Nursing (RCN) [1] to improve quality of inpatient care. Methods We developed the WRC (Figure 1) for a comprehensive patient review, got approved by the hospital health records committee and used as a sticky note in clinical notes.The WRC was designed to be used as a memory aid and not to limit critical clinical thinking.This was piloted in a medical ward and used during every WR. Results We collected data over a week on ward A (pilot medical ward) and a comparator medical ward (ward X -where WRC was not used).Among patients in ward A, a subgroup of patients in whom WRC was not used were analysed as a separate sub-group.Total of 45 patients were assessed during the period, 28 patients from ward A, 19 patients from ward X.Venous Thrombo-Embolism assessment and action was done in 96.4% (27/28) in ward A (100% in WRC used WR) whilst it was 73.6% (14/19) in Ward X.Resuscitation and escalation of care decision was made in 67% (19/28) in ward A (93.3% in WRC used WR). It was done only in 31.3% (6/19) of patients in Ward X.Antibiotic stop date was mentioned in 68.7% (11/16) in ward A (100% -7/7 in WRC used WR). It was done in 22.2% (2/9) in Ward X.Expected Day of Discharge was mentioned in 65.2% (15/23 -5 patients were very unwell to comment on EDD) in ward A (76.5% -10/13 in WRC used WR). It was done in 53.8% (7/ 13) of the ward X. Conclusion A recent NEJM article 2 evaluating the use of checklists for high-fidelity crisis simulation showed an impressive difference in missing critical steps, 6% with checklists vs 23% without checklists.The WHO has already recognised and introduced the surgical safety checklist to reduce morbidity and mortality.We believe that checklists have the potential to improve patient outcomes by ensuring that all patients receive evidence based best practices and safe high quality care. This allows physicians to concentrate on the higher thinking in WR and WRC to ensure that basics are covered.