Ward rounds: missed learning opportunities in diagnostic changes?

Bhangu, Aneel; Hartshorne, Gemma

doi:10.1111/j.1743-498x.2010.00408.x

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…Following the introduction of twice-daily consultant WRs in a large UK medical centre, average length of stay fell from 10.4 to 5.3 days (p < 0.01) without increasing readmissions [6]. Consultant-led surgical post-take WRs can also change initial admitting diagnoses in up to 27% of cases [7]. In another study, the use of a multidisciplinary ward round increased their educational benefit whilst also reducing length of hospital stay [8] and similarly, the presence of registered nurses has been shown to reduce adverse events and mortality [9].…”

Section: Discussionmentioning

confidence: 99%

Surgical ward rounds in England: a trainee-led multi-centre study of current practice

et al. 2014

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BackgroundRecent guidance advocates daily consultant-led ward rounds, conducted in the morning with the presence of senior nursing staff and minimising patients on outlying wards. These recommendations aim to improve patient management through timely investigations, treatment and discharge. This study sought to evaluate the current surgical ward round practices in England.MethodsInformation regarding timing and staffing levels of surgical ward rounds was collected prospectively over a one-week period. The location of each patient was also documented. Two surgical trainee research collaboratives coordinated data collection from 19 hospitals and 13 surgical subspecialties.ResultsData from 471 ward rounds involving 5622 patient encounters was obtained. 367 (77.9%) ward rounds commenced before 9am. Of 422 weekday rounds, 190 (45%) were consultant-led compared with 33 of the 49 (67%) weekend rounds. 2474 (44%) patients were seen with a nurse present. 1518 patients (27%) were classified as outliers, with 361 ward rounds (67%) reporting at least one outlying patient.ConclusionRecommendations for daily consultant-led multi disciplinary ward rounds are poorly implemented in surgical practice, and patients continue to be managed on outlying wards. Although strategies may be employed to improve nursing attendance on ward rounds, substantial changes to workforce planning would be required to deliver daily consultant-led care. An increasing political focus on patient outcomes at weekends may prompt changes in these areas.

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Section: Discussionmentioning

confidence: 99%

Surgical ward rounds in England: a trainee-led multi-centre study of current practice

et al. 2014

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“…Around half of surgical adverse events do not arise in the operating theatre and again many are likely to be related to poor ward management, either in preoperative assessment and/or post-operative care. 11,12,14,15,21 Ward rounds are one of the focal points of good extra-operative care and have a proven clinical benefit, [22][23][24][25][26][27] providing the main interface between the surgical team and patients: facilitating patient assessment, exchanges of information and management decisions. Unfortunately the quality of surgical ward rounds varies significantly and poor quality ward rounds have been shown to lead to a greater incidence of preventable complications in the High dependency Unit setting.…”

Section: Introductionmentioning

confidence: 99%

A Ward-Round Non-Technical Skills for Surgery (WANTSS) Taxonomy

Klaas

Murray

Maran

et al. 2020

Journal of Surgical Education

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Background: Around half of surgical adverse events occur outside the operating room. However the majority of non-technical skills (NTS) training programs have been developed for the intra-operative environment. Ward rounds are a crucial part of extra-operative care and to date no specific NTS training manual has been developed targeting emergency general surgical ward rounds. Aim: To develop a NTS taxonomy for emergency general surgical ward rounds that can be used to improve surgical team members' NTS and improve outcomes. Methods: A literature review of existing NTS taxonomies was conducted, followed by semi-structured interviews and observational data collection, to determine good and poor surgical ward round behaviours. These behaviours were reviewed by a panel of subject matter experts and categorised into a taxonomy, using the Non-Technical Skills for Surgeons (NOTSS) taxonomy framework as a guide. Results: The Ward-round Non-Technical Skills for Surgery (WANTSS) taxonomy includes examples of good and poor ward round specific behaviours, grouped into elements and categories. The taxonomy can be used as both a training and teaching manual for the surgical team. Conclusion: Ward rounds are a crucial part of extra-operative surgical care. The WANTSS taxonomy provides surgical teams with a manual to help them improve their ward round NTS.

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“…Interestingly, the provisional diagnosis was frequently altered in 27% of cases at PTWRs. Sadly trainees who miss PTWRs due to working hour restrictions fail to learn from their mistakes [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

“The Longest Way Round Is The Shortest Way Home”: An Overhaul of Surgical Ward Rounds

et al. 2017

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BackgroundWard rounds, a keystone of hospital surgical practice, have recently been under the spotlight. Poor-quality ward rounds can lead to a greater number of adverse events, thereby cascading to an increased financial strain on our already burdened healthcare systems. Faced with mounting pressures from both outside and inside health organizations, concerted efforts are required to restore it back into prominence where it can no longer take a backseat to the other duties of a surgeon.MethodsThe nucleus of this narrative review is derived from an extensive literature search on surgical ward rounds.ResultsIn this review, we focus on the need for reforms, current characteristics of surgical ward rounds, obstacles encountered by competing interests and proposed solutions in delivery of effective ward rounds that can meet with newly laid guidelines.ConclusionWard rounds should be standardized and prioritized to improve patient care.

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Ward rounds: missed learning opportunities in diagnostic changes?

Cited by 7 publications

References 24 publications

Surgical ward rounds in England: a trainee-led multi-centre study of current practice

Surgical ward rounds in England: a trainee-led multi-centre study of current practice

A Ward-Round Non-Technical Skills for Surgery (WANTSS) Taxonomy

“The Longest Way Round Is The Shortest Way Home”: An Overhaul of Surgical Ward Rounds

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