Re: Restore the prominence of the medical ward round
We read with interest Cohn’s personal view about the importance of the medical ward round(1). While the comparison of the medical ward round with a surgeon’s focus on performing operations is useful in highlighting the necessity for hospital’s resource allocation to allow patients to be reviewed by properly experience clinicians, it risks diminishing the importance of surgical ward rounds. The regular review of surgical patients by experienced doctors is essential to detect any deviation from an uncomplicated recovery (during both emergency and elective care) at the earliest opportunity to minimise any additional morbidity. We have recently performed a prospective study of surgical ward rounds, which assessed 5622 patient encounters across 19 centres. Of these, only 2,676 (48%) were by a consultant, most of the remainder being by registrars. The pressure on surgical consultants to maximize throughput during direct clinical care (DCC) programmed activities (PAs) would appear to prevent them from partaking in the routine ward round. In our study, the proportion of patients reviewed by a consultant at the weekend - when there are less/no DCC PAs- rose to 78%.
Substantial re-organisation of consultant job plans would be required to free them from other activities and allow them to focus on ward rounds. There has recently been some media attention on ward round practice following publications from several Royal Colleges (2,3). all highlighting their importance in the timely organization of investigations and discharge of patients. Moreover, in these financially straightened times, the pressure to maximize income has never been greater, and both surgical and medical consultants must therefore strive to protect this precious and powerful tool.
1. Cohn A. Restore the prominence of the medical ward round. BMJ. 2013 Oct 31;347(oct31 2):f6451–1.
2. Royal College of Physicians, Royal College of Nursing. Ward rounds in medicine: principles for best practice. London: RCP, 2012
3. Academy of Medical Royal Colleges (2012). Seven Day Consultant Present Care. London: AOMRC, 2012