The use of a pro forma to improve quality in clerking vascular surgery patients

Abstract

At our institution, a large tertiary referral centre for vascular surgery, patients are often admitted directly to the ward and clerked by foundation year one (FY1) doctors. We found that these clerkings frequently fell short of national record keeping standards, potentially leading to an increased risk for patients during their hospital stay. In addition, we found that junior doctors did not feel confident in clerking vascular surgery patients.A literature review found that high quality clerkings were strongly linked to improved patient safety, and that the use of a pro forma was one method to improve compliance with documentation guidelines. We devised a clerking pro forma based on national guidelines and introduced it to the department.We found that the use of a pro forma significantly improved documentation standards across a number of domains, including patient demographics, presenting complaint, and family and social histories (p <0.05). Examinations were significantly more comprehensive, with cardiac and vascular examination as well as peripheral pulses documented (p <0.05).In conclusion, we found that using a pro forma helped to aid junior doctors in clerking new patients, and significantly improved the quality of their history and examinations. This leads to a potential positive impact on patient safety during their inpatient stay, and should be rolled out more widely across the hospital.

Improving the Hip Fracture Surgical Consenting Process: A Single Centre Multi-Cycle Quality Improvement Process

“…However often the clerking doctor may not be the surgeon performing the procedure and can be a relatively junior grade who is working under significant time or work pressure (4). These pressures have been noted to result in poor documentation and missed elements of admission notes (5) which can render important documentation such as consent forms substandard or even invalid (4).…”

“…Reviews of consent documentation for common trauma procedures have found poor documentation of risks (8) often with a wide variety of complications listed for the same procedure in varying frequencies (9). These deficiencies in documentation have been attributed to not only the aforementioned work pressures but also poor overall awareness of local or national guidelines and standards (10), which is often exacerbated by a relatively rapid turnover of junior staff (rotating as frequently as every 4 months) (5). This is despite Department of Health and Royal College of Surgeons guidelines on consent that state the person obtaining consent should have clear knowledge of the procedure along with the potential risks and complications (11,12).…”

Improving the surgical consenting process for patients with acute hip fractures: a pilot quality improvement project

“…However often the clerking doctor may not be the surgeon performing the procedure and can be a junior grade physician who is working under signi cant time or work pressure (4). These pressures have been noted to result in poor documentation and missed elements of admission notes (5) which can render important documentation such as consent forms substandard or even invalid (4).…”

“…Reviews of consent documentation for common trauma procedures have found poor documentation of risks (8) often with a wide variety of complications listed for the same procedure in varying frequencies (9). These de ciencies in documentation have been attributed to not only the aforementioned work pressures but also poor overall awareness of local or national guidelines and standards (10), which is often exacerbated by a relatively rapid turnover of junior staff (rotating as frequently as every 4 months) (5). This is despite Department of Health and Royal College of Surgeons guidelines on consent that state the person obtaining consent should have clear knowledge of the procedure along with the potential risks and complications (11,12).…”

Evaluation of conventional lecture method versus PBL (Problem Based Learning) using the cases notes prepared by new graduates.

“…Various departments have now devised their own specific performa which has sections to be filled with key history points. [2][3][4][5] Problem based learning (PBL) in various ways has become popular in medical schools over the past few years. There was serious division seen between the supporters and the skeptics when the teaching patterns was switched for the first time, and serious concerns were seen regarding the quality and level of knowledge being conveyed to the students.…”