EGS P26 Facilitating the Emergency Surgical Ward Round: The Route to WardNav

Abstract

Abstract Background The ward round is a corner stone of surgical practice, this is no different when dealing with the acute surgical take. Constant bed pressures result in frequently needing to visit multiple wards, requiring time and effort on staff to ensure patients are reviewed. With frequent rotation of junior doctors, often the responsibility of planning the ward round falls to the ward round leader, who is also making the clinical decisions. We hypothesise a ward round planning tool available to the surgical team would result in more efficient ward rounds, freeing the team to focus on clinical decisions. Methods A survey of junior doctors (foundation doctors and core trainees) was distributed assessing their level of engagement with ward round planning while on surgical rotations at Southmead Hospital, Bristol. An initial planning tool was created in Microsoft Excel utilising a node edge graph and an algorithm based on the Hamiltonian cycle. After further survey feedback, the tool was developed into a web-based app using a version of Djikstra’s algorithm. Results 25 junior doctors responded to the initial survey over two rotations. 100% had to go to multiple wards on a round, 64% actively think about the route required although only 28% would be confident in planning the route. 96% would find a planning tool helpful. Feedback on the Excel based tool from the first cohort revealed appetite for a mobile app-based version. The resultant application was created in R. The final version allows the user to start the round on any ward and creates the optimal route through the building, visually represented on a graph with accompanying text output. Conclusions Junior surgical doctors are not confident with planning ward rounds in a large teaching hospital. An app-based ward navigation tool has the potential to remove ward round planning from daily decision making and engage the junior surgical staff.