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Results
25 of 48 (52%) FY1s completed the survey.92% of respondents received the aide-mémoire at induction; 58% kept it with them.
BackgroundWard rounds are a fundamental aspect of the care of medical inpatients but surprisingly, how to conduct them is not formally taught1. The Royal College of Physicians describes medical ward rounds as ‘a complex clinical process during which the clinical care of hospital inpatients is reviewed’, but they recognise that a number of important aspects are often forgotten2. Acknowledging human factors in the busy hospital environment with the use of a checklist may help improve patient safety and the quality of the ward round3. In June 2015 we had conducted a survey of Foundation Year 1 doctors (FY1s) at North Lincolnshire and Goole NHS Foundation Trust (NLaG), which showed FY1s were frequently leading their own ward rounds , felt unprepared to do this, and several aspects were often not considered. We introduced an intervention of an aide-mémoire in August 2015.
Methods
We disseminated an online survey to all Foundation Year 1 doctors (FY1s) at North Lincolnshire and Goole (NLaG) NHS Foundation Trust in May 2016 to assess how prepared FY1s felt to deliver ward rounds, how often they did so alone, whether they considered a number of important aspects, and the effectiveness of the aide-mémoire intervention.
Key messages FY1s at NLaG are regularly conducting ward rounds without a senior present and
do not initially feel prepared to do so Aide-mémoire was perceived as useful by some individuals Better support and training is still required to help FY1s deliver and lead safe,
systematic and thorough ward rounds at NLaG
Discussion• FY1s feel unprepared to lead ward rounds• Internal validity supported by 52% response rate; external validity limited by only one trust• 56% thought aide-mémoire was useful to remind them of aspects to consider; 58% had kept it with them• 36% of FY1s agreed that it helped them to feel more prepared• Potential recall bias • Time pressures, interruptions and individuality of patients on wards cannot be overcome by aide-mémoire • Better support and training is still required to prepare FY1s• Questions have been raised about the appropriateness of FY1s leading ward rounds so frequently• Aide-mémoire is a low cost intervention and some benefit perceived; continue use• Wider study regarding FY1-led ward rounds and potential interventions would be valuable
Results
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
2015Observations 2016
2015Investigation results 2016
2015History (e.g. Progression/New symptoms/Pain/Bowels) 2016
2015Examination 2016
2015Fluid input/output & IV fluids 2016
2015Patient concerns 2016
2015Nutrition 2016
2015Mobility 2016
2015VTE prophylaxis 2016
2015Medications 2016
2015Referrals/MDT input 2016
2015Check patient concerns/understanding 2016
2015Ceiling of care 2016
2015Discharge planning 2016
Always Frequently Occasionally Rarely Very rarely
I received it on the first day… had a quick read, kept it in my ID badge holder but never took it out again after that.
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At the start of my medical rotation, without the aide-mémoire, I feltprepared to do so.
At the start of my medical rotation, with the aide-mémoire, I feltprepared to do so.
On the scale below, how much do you agree with the following statements about leading your own ward rounds (without a more senior doctor present)?
Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree I did not have access an aide-mémoire
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The credit card sized aide-mémoire was useful in reminding me ofaspects to consider.
The credit card sized aide-mémoire helped me feel more prepared todo so.
On the scale below, how much do you agree with the following statements about leading your own ward rounds (without a more senior doctor present)?
Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree I did not have access an aide-mémoire
<1/week8%
1/week4%
2/week20%
3/week64%
>3/week4%
During your medical rotation in FY1, on average, how often did you lead your own ward round (i.e. do a ward round without a more senior doctor present)?
Comparison between survey findings in 2015 and in 2016When you saw a patient on a medical ward round (without a more senior doctor present), how often did you consider the
following:
Hull York Medical School, York, YO10 5DD
Dr Melody Redman1, Dr Sareena Gajebasia1, Dr Jessica Pearce1, Dr Ruth Dirksen2, Dr Ian McNeil2
1: Hull York Medical School, UK; 2: North Lincolnshire and Goole NHS Foundation Trust, UK
Email: [email protected]
Ward rounds: When FY1s take the lead
References1. General Medical Council. Outcomes for Graduates (Tomorrow’s Doctors). Available from: http://www.gmc.uk.org/Outcomes_for_graduates_Jul_15.pdf_61408029.pdf [Accessed 24th May 2016].2. Royal College of Physicians. RCP Ward Rounds in Medicine: Principles for best practice. Available from: https://www.rcplondon.ac.uk/sites/default/files/documents/ward-rounds-in-medicine-web.pdf [Accessed 24th May 2016].3. Norris B, Currie VL, Lecko C. The importance of applying human factors to nursing. Nursing Standard. 2012;26(33):35–40.
Good reminder to be thoroughon ward rounds.
To be honest, you learn as you go… you simply don't have the time to go through each and everything listed
I received it on the first day… had a quick read, kept it in my ID badge holder but never took it out again after that.
