Implementation of a Checklist for Surgical Inpatient Rounds: An Observational Cohort Study.

Abstract

Background: The surgical ward round is the linchpin of inpatient care. Despite this, it is often pressured by external forces such as theatre times, on-call demands, or outpatient clinics. Checklists have been successful in saving lives, particularly in the operating room. Some of this work has translated to the surgical ward round, but no studies have examined the direct impact on patient communication. As a result, this study aimed to determine how a structured checklist impacted documentation and discussion in the surgical ward round.

Methodology: A pre-observational and post- observational cohort intervention study was conducted to examine the impact of a 17-item checklist on the surgical ward round. Ward rounds were filmed to evaluate clinical documentation and discussion.

Results: One hundred thirty-five patient encounters were recorded and transcribed over 24 months: 65 pre-intervention and 70 post-intervention. There were 59 females and 76 males. The mean age was 62 (SD=15.2). There were 105 benign cases, 30 malignant cases, 32 elective patients, and 103 emergency patients. The documentation of 'medication review', 'investigations', and 'patient concerns' significantly increased following the implementation of a checklist. Documentation of 'impression' significantly decreased. Doctor-patient communication and collaborative discussion rates of important items were not impacted by the checklist.

Conclusions: This checklist did not improve discussion in the surgical ward round. However, it improved the documentation of several items on the checklist (patient's medication, investigations, and concerns). This study identifies areas where checklists can positively improve the ward round and highlights the significant areas where improvements can be made.