Quality and safety at the point of care: how long should a ward round take?

Abstract

-In April 2009 a 'considerative checklist' was developed to ensure that all important aspects of care on a team's routine and post-take general internal medicine ward rounds had been addressed and in order to answer the question: How long should a ward round take, when conducted to high standards of quality and safety at the point of care? The checklist has been used on 120 ward rounds: 90 routine ward rounds and 30 post-take ward rounds. Overall, the average time per patient was 12 minutes (10 minutes on routine rounds and 14 minutes on post-take rounds). The considerative checklist has encouraged and enabled documented evidence of high quality and safe medical care, and anecdotally improved team working, communication with patients, and team and patient satisfaction.

Safety in numbers: lack of evidence to indicate the number of physicians needed to provide safe acute medical care

“…23 An American study similarly noted a median time of 13 minutes per patient on consultant rounds. 24 Multiple factors were noted as impacting on the length of consultant rounds, including the seniority of the consultant physician 25 and the presence of students on the round.…”

Physician experiences of patient-centered and team- based ward rounding – an interview based case-study

“…This is in line with Stickrath and colleagues [37] who reported great heterogeneity and large time variation between individual physicians, rounding on average nine patients in two hours, approximately 14 minutes per patient. A high-quality ward round, following the Caldwell considerate checklist, took 12 minutes per patient, with considerable variation [38] . Large variation between physicians time-motion patterns during walking rounds was also reported using real-time location systems [39] .…”

Rocket scientists need not apply

“…EBUS-TBNA attracts a far higher specific tariff than conventional fibreoptic bronchoscopy: nearly seven times more (£3404 (E63.2 + T87.4) versus £504 respectively). 3 We (as well as the Audit Commission) have also previously demonstrated significant inaccuracies in coding in the field of interventional pulmonology, with >15% coding inaccuracy in a single centre for EBUS-TBNA and >68% inaccuracy for local anaesthetic thoracoscopy, with estimated financial discrepancies of at least £65,000 for one procedure in one centre annually. 4,5 We have managed to prevent all EBUS-TBNA coding errors by electronically notifying all procedures anonymously to a key member of the coding team after each procedure session, verified by independent cross-checking of the tariff applied and a monthly checklist from the coding team.…”

“…Benefits from a post-take ward round checklist have been demonstrated elsewhere. 3 A national drug chart (as in Wales) 4 would be useful. Electronic prescribing may not be the cure-all that is hoped for and it will need the same national evidence-based approach.…”