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Recent rapid responses
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Dear Sirs
We thoroughly agree with the joint statement by the RCP and RCN. The ward round is critical to the work of all nursing, medical and para-medical staff on any hospital surgical or medical unit yet currently little specific teaching or assessment of a ward round is ever undertaken. On a busy surgical unit the daily business ward round is frequently led by the StR, where the skills required by the lead doctor include decision making, problem solving, organisational skills, prioritisation, leadership and professionalism as well as an expected clinical knowledge base. Good communication with all staff and all levels of staff and patients would be essential.
In this era of surgical competency based training we felt this should be addressed through the ISCP (intercollegiate surgical curriculum project) WPBAs (work place based assessments). We have designed and are currently trialling a new WPBA designed specifically to assess the ward round, which is mapped to the surgical curriculum as articulated through the ISCP and with a format that is familiar and easy to use. The Ward Round Assessment Tool (WRAT) has been designed to assess key areas such as medical and surgical knowledge, communication between staff and with patients, clinical history checking, progress checking, ensuring patient inclusion and understanding, patient safety issues such as venothromboembolism risk assessment, patient nutrition, drug prescribing and pain management and finally written communication.
We hope that the establishment of a formal ward round assessment will encourage regular Consultant-led teaching ward rounds and by keeping the format of reporting the WRAT in a similar suite to that of other WPBAs in the ISCP system there will be familiarity for both trainer and trainee
The WRAT had already been piloted amongst trainees in an ENT Surgical Unit of a District General Hospital (The Royal Shrewsbury Hospital) in the West Midlands with promising results and a more comprehensive multi-speciality deanery trial is currently in progress.
Competing interests: The results of the pilot study have been accepted for publication in the Bulletin/Annals of the Royal College of Surgeons
Royal Berkshire Hospital, London Road, Reading
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+Last week my consultant echoed the call to restore consultant-lead ward rounds to their 'former glory'. He lamented that in the past the important task of writing in the notes used to fall to the most senior member of the team, rather than the most junior. Unfortunately, when I offered him my stack of notes and my pen he was less than impressed.
Competing interests: None declared
University Hospitals of Leicester, Leicester Royal Infirmary
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+Whilst it is a welcome call to improve and reinstate the status of regular ward round, I feel that modern medicine and nursing may prevent this for several reason. Firstly,gone are days that there are "teams" on a ward. Very often several teams cover a single ward with outliers distributed amongst the dedicated speciality. Secondly, the demands that the EWTD has placed on compliant rotas mean that juniors are often away post nights, pre nights or on nights and some days, there is a solitary junior on the ward alone. Thirdly, and perhaps most controversially, Doctors often find that when they are on a round and request the attendance of a nurse we are told they are on their break or they are not caring for that particular patient. Surely we all care for our patients and they are all our responsibility.
With the pressures on time increasing, and consultants and registrars having to fit in more clinics, procedural lists, outlying hospital visits etc... How do the teams ensure morning ward round if there are endoscopy lists, clinics etc... Should the rounds start early, expect the juniors to come in early and therefore break the hallowed EWTD and contracted hours? I question how these regular ward round and feedback can take place. Doctors struggle to fit in the required jobs in a day as it is, without now having to provide a written summary to each family on the events of the ward round.
In our hospital our team employ a policy of open ward round where families are informed of the consultant ward round times (3 times a week) and the registrar ward round (once a week) and can attend, and are actually encouraged to attend to discuss concerns or receive updates. In addition, like the familiar drug round nurse sachets worn by staff, we also have a do not disturb ward round in progress overall that is worn so that everyone knows the team is on a round. How this would work in larger hospitals is still to be seen.
Competing interests: None declared
Prince Phillip Hospita, Dafen, Lanelli SA14 8QF
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