Evaluating the impact of a new consultant ward round


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Vishal Navani1, David Bloomfield1, Ghomaissa Rosie1, Reshma Ghedia1
1Brighton and Sussex University Hospitals, Brighton, UK

Background

Regular consultant ward rounds have been shown to reduce length of stay and improve discharge planning for patients1. Balancing the competing demands of outpatient activity and inpatient oncology care has been difficult in our hospital. Previously there was no timetabled inpatient oncology consultant ward round. Inpatients were managed primarily by oncology specialist trainees, with ad-hoc review by their named consultant. A regular consultant ward round was introduced for the first time on the 7/1/13. Each consultant was timetabled to give a twice weekly ward round. Whilst on the ward they provided cover for all inpatients, regardless of tumour site.

Method

To evaluate this, a retrospective case note analysis was undertaken. This included all oncology patients admitted for the two months preceding and succeeding the new ward round. For each patient the length of stay, time to first consultant review, number of consultant reviews and time to discharge post consultant review was identified. A staff survey also took place. Statistical analysis was performed using Mann-Whitney U or Chi-Squared tests.

Results

85 patient episodes meeting the inclusion criteria were identified. Case notes were avaialble for 63 (74%). The average length of stay decreased significantly from 11 to 3.5 days (p<0.05). The time to discharge after consultant review also signficiantly decreased from 6 to 2 days (p<0.05). The number of consultant reviews and time to consultant review remained unchanged (p>0.05). The percentage of patients receiving a consultant review increased, from 54.4% to 71.4%. Though not statistically significant, it is likely to be clinically so. Staff satisfaction also improved.

Conclusion

This suggests that a regular consultant ward round shortens patient length of stay, possibly through expediting treatment and discharge decisions after first review. Further work is needed to establish exactly how this is achieved and how to make the new ward round a permanent feature logistically.