Improving multidisciplinary communication at ward board rounds using video enhanced reflective practice

Abstract

The priority to ensure patient safety and use resources effectively, demands attention and innovation. Video enhanced reflective practice (VERP) provides training based upon analysis of film clips of one's professional practice to develop practical insight into the processes of communication, so that effective changes can be made to ongoing behaviour and practice.In this case the focus was on multi-disciplinary communication within daily board rounds on an acute medicine and care of the elderly ward.Baseline assessment and post intervention testing of perceptions of change by both full and core team were undertaken to establish the impact of VERP training. In addition pre and post focus group discussion and film analysis supplemented evaluation.The findings support the view that after VERP training of a core team, board rounds were seen as consistently easier to participate in, providing improved focus, were more efficient in goal setting and resulting in better care for patients as well as improved pathways to discharge. This suggests benefits to the communication "culture" of a multidisciplinary team resulting in increased benefits for the wider team.It is concluded that the use of tailored VERP training for personal, professional and team development is relevant, feasible, and worthy of further testing and investigation. ProblemA board round is a process which should improve communication among the multi-disciplinary team (MDT), enhancing team working and providing a more coordinated approach to discharge planning.In our pilot ward, an acute medical and care of the elderly ward, board rounds had been in place for around three years. For the board round all team members are expected to assemble at 11.10 am each morning in front of the white board at the nurses station.This board contains patient details including planned date of discharge, any risk factors to patient safety and input from physiotherapy,occupational therapy or social work. The board rounds are attended by the nurse in charge, consultant, middle grade and junior doctors, junior and senior nurses, social worker, physiotherapist, occupational therapist and ward clerk among others. There follows a twenty minute discussion of the thirty inpatients in the ward with an emphasis on facilitating early and safe discharge. This process requires efficient communication of all and input from different members of the team depending on the case discussed. An inefficient board round process leads to delays in discharging patients. In our pilot ward it was recognised that board rounds were often not as efficient and useful as they could be.Rarely was it possible to contain the discussion to its allocated time of twenty minutes, and there were frequent distractions and often not all staff were present. Some improvement work had already been undertaken as part of a breakthrough series improvement collaborative (OPAC) in NHS Tayside which set out to improve the experience of older people in our acute care hospital wards.Several PDSA (Plan, Do, Study, Act) ...

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