‘Make ward rounds the cornerstone of care’ is the title of a recent press release issued jointly by the Royal College of Physicians and royal College of Nursing. The statement goes on to call for ‘a concerted culture change with clinical staff, managers and hospital executives engaging with, and focusing on, improving the quality of ward rounds’
Why are ward rounds so important? They are a tangible representation of responsibility, communication and team work. They are a classic example of an entity equalling more than the sum of its separate parts. Sometimes the old way is actually the best way. Routine may be the enemy of creativity but it is the lifeblood of consistent care. In a traditional hospital setting the ward round really was the heartbeat of ward life.
Progress into the 21st Century and shifts in hospital hierarchy at least means that the consultant is no longer (at least not usually) the pompous omnipotent demigod portrayed as Sir Lancelot Spratt in the comedy films in the 1950’s. A vast improvement in cross disciplinary respect, a growing understanding of nursing, paramedic, therapy and support roles and hopefully a regular dose of good manners means that each professional along the patient pathway has a valued part to play in patient care.
An uncomfortable thread that runs through iatrogenic (literal translation – ‘physician-induced’) tragedies is poor communication and blurred lines of responsibility among the medical staff. In the same way that team meetings keep commercial departments on track, so patients can benefit from regular contact and review with their medical team. Switched on patients and their relatives can also gain additional insight and feel more in control of their destiny if they can see and speak to their medical team as one entity.
The press release offers recommendations for a well-run ward round which make remarkably good sense. Such good sense in fact, that it seems shocking that many hospital wards do not currently follow this good advice:
· Preparation for the ward round should include a pre-round briefing.
· Consultant-led ward rounds should be conducted in the morning to facilitate timely completion of tasks during the working day.
· A nurse should be present at every bedside as part of the ward round.
· Patients, carers and relatives should be provided with a ‘summary sheet’ clearly presenting information discussed in the ward round.
· Patients with dementia and learning disabilities should be supported as far as possible to make decisions about their care.
· Patients’ records should be kept centrally to promote effective communication and team working.
· Ward-round teams should utilise locally adapted checklists to reduce omissions, improve patient safety and strengthen multidisciplinary communication.
As our previous Secretary of State now famously said of the health reforms ‘the patient should be at the heart of everything we do’ and ‘nothing about me without me’. Worthy sentiments even if you are not a fan of a top down reorganisation. It’s at the coal face of care where improvements are most important.
Regular ward rounds are a very good place to start.