Aims With increasing pressures on NHS services it is imperative that we maintain high quality service and documentation while streamlining processes to best utilise staff time. Our quality improvement project aimed to improve ward round efficiency while improving documentation standards in our tertiary Neonatal Unit by introducing an electronic ward round solution.
Methods Ward round mapping using a Vanguard (productive ward) method approach identified that 56% of ward round time was spent on paperwork, this was mirrored by an online anonymous questionnaire where 53% of staff felt too much of the ward round was taken up by paperwork. Historical data showed only 68% of entries in the medical notes to be legible, only 84% had patient identifiers on each page, and while all entries were dated, only 66% had a time recorded.
An Excel spreadsheet was designed and programmed which would pre-populate a ward round proforma using information stored in the handover sheet, and changes made would be reflected in the handover sheet. Ward rounds were conducted using a computer-on-wheels, printed via wireless and filed into patient notes.
Results Ward round length each day was recorded by the attending junior doctor and charted into an SPC run chart (Figure 1) for analysis. Pre-intervention average ward round time was 4h58m (Q1-Q3 5h35m – 4h20m), this reduced after the introduction of electronic ward round by 19% (57 minutes) to 4h01m (4h37m – 3h23m) (Table 1).
As the electronic solution automatically placed the time, date and patient identifiers on each page and the entries were all typed, all ward round entries completed using the electronic system met 100% on each of these standards.
Conclusion Use of a low cost unified electronic ward round and handover solution demonstrated a significant reduction in average ward while simultaneously improving documentation standards. Earlier completion of the ward round released staff to spend more time with patients and their parents and completing routine work during daytime hours.