Multidisciplinary Team Communication Research Articles

Nursing staff adherence to guidelines on nutritional management for critically ill patients with cancer: A service evaluation.

Critically ill patients with cancer are at high risk of developing malnutrition, negatively affecting their outcome. To critically analyse nursing staff's adherence to nutrition management guidelines for critically unwell patients with cancer and identify barriers which prevent this. Two areas of nutrition management were evaluated: early initiation (<48 h from admission) of enteral nutrition (EN) and continuation of EN without interruption. A retrospective data analysis was performed on mechanically ventilated adult patients admitted to a single cancer centre. Data from electronic patient records (EPR) were collected. Health care professionals' (HCP) documentation was analysed, and a nursing staff focus group (n = 5) was undertaken. Sixty-four patient records were included. Early EN was not administered in 67% (n = 43) of cases. The reasons for the three longest interruptions to EN feed were as follows: delays in EN tube insertion, gastric residual volumes (GRVs) less than the recommended feed discontinuation threshold and endotracheal intubation. Four main themes relating to barriers to practice were identified from the focus group data analysis: HCPs' approach towards nutrition management, the patient's physiological condition and stability, multi-disciplinary team (MDT) communication and guidance on nutrition management, and practical issues with patient care. Multi-disciplinary communication difficulties, lack of clear guidelines and inadequate awareness of the importance of nutrition for critically ill patients with cancer were barriers identified preventing optimal nutrition management. Nursing education is fundamental to help break down the barriers to practice which prevent critically ill patients from receiving optimal nutrition management.

1705 Geriatrician involvement with community multi-disciplinary teams to support people living with frailty and reduce readmissions

Abstract Introduction Factors contributing to frailty result in increased hospitalisations, with 5- 10% of patients attending Accident and Emergency department living with frailty, and 30% of those patients admitted to acute medical units (Conroy, 2013). Hospital admissions result in functional decline and deconditioning (Get It Right First Time, 2021). The number of people in the UK over the age of 85 is set to double in the next 20 years and treble in the next 30 (Office of National Statistics, 2013). Their needs are best met in the community with a multi-disciplinary approach. Method Patients, residing in Benfleet and Leigh-on-sea, discharged from Geriatric wards at Southend Hospital were identified during ward MDT meetings. Inclusion criteria: • Recurrent admissions • Prolonged hospital stay • Clinical Frailty Score &amp;gt; 5 • Social support Using this criteria, 216 patients were included. 7-day readmission and 30 day readmission data was collected and compared to readmission rate prior to intervention. Intervention On discharge patients were linked with Frailty Nurses within their Primary Care Network and were reviewed within 48-72 hours of discharge. Community support was provided via MDT, with involvement from consultant geriatrician. Concerns that could result in readmission were highlighted during these meeting, with patients being seen in Day Assessment Unit for review of sub-acute frailty syndrome if appropriate. Results Following intervention of utilising community MDT there was a reduction in rate of readmission. 9 patients (4.1%) were readmitted within 7 days of discharge and 14 patients (6.4%) were readmitted within 30 days, in comparison to 7.6% and 19.3%, respectively, prior to commencement of MDT. Conclusion This concludes that utilising community MDT with review following discharge has positive impact in reducing readmission rates. Highlighting potential risks of readmissions allows the MDT to address issues within the community and use bridging services appropriately.

Beliefs and Self-Perceptions of Spanish Mental Health Professionals about Physical Therapy in Mental Health: An Observational Survey Study.

The aim of this study is to understand the image, perception, and beliefs regarding the role of the physiotherapist in the field of mental health physiotherapy, both among the professional community and other multidisciplinary teams. An observational phenomenological qualitative study through the administration of an ad hoc survey comprising both categorical and open-ended as well as quantitative questions was conducted. A total of 368 responses were analysed. The participants comprised 78.4% women with a mean age of 37.5, an average professional experience of 14.33 years, and 88.3% practicing physical therapists. From the qualitative analysis conducted, three categories emerged in relation to the obtained responses: (a) functions with codes of "improving quality of life" and "intervening in physical pathologies"; (b) objectives with codes of "Improving quality of life", "Intervening in physical pathologies", "Functional rehabilitation", "Health promotion", and "Intervening in mental disorders"; and (c) image with codes "unfamiliarity", "holistic vision", "necessity", and "importance". Regarding the tools, the findings highlight a strong focus on physical exercise interventions due to their well-established benefits. Cognitive strategies like therapeutic relationships and cognitive-behavioural techniques were also prominent. Additionally, embodiment techniques involving movement, relaxation, breathing, and voice usage were notable. Lastly, manual therapy and physical agents formed another distinct category. The vision and role of this professional profile were unknown to the respondents. Despite being perceived as having a holistic view of the patient and being considered an essential need, the actual image remains vague. However, there is significant interest, indicating a promising future, although the lack of specialized training is noted. Therefore, the need for specialized education and awareness campaigns among professionals in the mental health field is highlighted.

The Exploration of Integrating the Midjourney Artificial Intelligence Generated Content Tool into Design Systems to Direct Designers towards Future-Oriented Innovation

In an age where computing capabilities are expanding at a breathtaking pace, the advent of Artificial Intelligence-Generated Content (AIGC) technology presents unprecedented opportunities and challenges to the future of design. It is crucial for designers to investigate how to utilize this powerful tool to facilitate innovation effectively. As AIGC technology evolves, it will inevitably shift the expectations of designers, compelling them to delve deeper into the essence of design creativity, transcending traditional sketching or modeling skills. This study provides valuable insights for designers on leveraging AIGC for forward-thinking design innovation. We focus on the representative AIGC tool, “Midjourney”, to explore its integration into design systems for collaborative innovation among content creators. We introduce an AIGC-based Midjourney path for product design and present a supporting tool card set: AMP-Cards. To confirm their utility, we undertook extensive validation through advanced prototype design research, task-specific project practices, and interdisciplinary collaborative seminars. Our findings indicate that AIGC can considerably enhance designers’ efficiency during product development, especially in the “explorative product shape” phase. The technology excels in identifying design styles and quickly producing varied design solutions. Moreover, AIGC’s capacity to swiftly translate creators’ concepts into visual forms greatly aids in multidisciplinary team communication and innovation.

Introduction of a Systemic Innovation Management Model for Facilitating Process Innovation

Abstract Within health care projects for change and innovation, professionals should ambitiously cooperate in order to yield a creative multidisciplinary mindset for guaranteed innovative output. Failure of innovation projects is amongst others due to deterioration and insufficient focus on relational aspects. Aim; an innovative management tool for facilitating process innovation is launched. Methods; Systemic innovation (SI) is a social network management model, subsidiary to actual management models for quality improvement and innovation. The SI management model yields essential tools for stimulation of communication in multidisciplinary teams in order to shape alternative mindsets. Results; The key domains of SI representing socio-dynamics, value of arguments and flexibility for change concern topics for assessment of behavior with regard to psychosocial and organizational characteristics. The key domains yield a format enabling a critical appraisal concerning improvement of socio-technologic aspects in case of process innovation. Conclusion; SI yields a format for stimulation of social awareness with regard to self-assessment, interoperability and mindset generation in multidisciplinary teams of professionals.

Allied health professionals’ views on important outcomes of children’s elective lower limb orthopaedic surgery: a qualitative interview study to inform a core outcome set

Purpose A common methodological limitation of research that guides surgical procedure selection for children’s elective lower limb orthopaedic surgeries is inconsistent outcome selection. Improving outcome consistency can be achieved through the development of a core outcome set (COS). The aim of this study is to identify which outcomes are considered important for children’s elective lower limb orthopaedic surgeries by allied health professionals (AHPs) and explore why they select these outcomes, to inform a COS development project. Methods Online semi-structured interviews were conducted with relevant AHPs. Participants were selected using maximum variation purposive sampling; selection was based on profession and inpatient/outpatient role. The data set was analysed using an inductive and deductive approach to thematic analysis. Results Four physiotherapists, three orthotists, three prosthetists, and two occupational therapists were interviewed. Most identified outcomes of importance related to “activities and participation”. From the data, we conceptualised that AHPs with effective multidisciplinary communication focused on child-centred outcomes, while clinicians with limited multidisciplinary teamwork focused on role-based outcomes. Conclusions There is concurrence between outcomes identified as important in this study, and other qualitative studies in similar populations. These important outcomes were seldom measured in previous studies or in routine clinical practice. Implications for rehabilitation Allied health professionals (AHPs) prioritise activity and participation outcomes after children’s elective lower limb orthopaedic surgery. It is important to the rehabilitation of children after elective lower limb orthopaedic surgery that all involved AHPs collaborate with the wider multidisciplinary team. Multidisciplinary team communication encourages collaborative outcome identification, and discourages role defined outcome focus.

Establishing a Comprehensive &amp; Coherent Definition of Parent Responsiveness for Enhanced Multidisciplinary Team Communication in Early Intervention

Abstract Date Presented 04/21/2023 This systematic review of multidisciplinary literature yielded a comprehensive definition of parent responsiveness to infant cues that OT practitioners can use when communicating with interdisciplinary early intervention teams. Primary Author and Speaker: Emily Campi Additional Authors and Speakers: Elizabeth Nye Contributing Authors: Grace Baranek

P145 Association between musculoskeletal ultrasound and the Rheumatoid Arthritis Foot Disease Activity Index in managing the rheumatoid foot

Abstract Background/Aims In rheumatoid arthritis (RA), foot synovitis is frequently evident in patients in DAS-28 remission, placing them at risk of radiographic joint damage. This has been attributed to the omission of foot and ankle joint counts from the DAS-28. The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) is a valid, reliable, and feasible tool and can be used as an adjunct to the DAS-28 to quantify foot disease activity. Recent qualitative research suggests that rheumatologists perceive validation of the RADAI-F5 against musculoskeletal ultrasonography (MSUS) as essential prior to clinical implementation. Accordingly, this study aimed to evaluate the construct validity of the RADAI-F5 relative to MSUS and clinical examinations of foot disease activity. Methods People with RA were recruited from 3 NHS Rheumatology Outpatient services in Scotland. Participants attended a single research visit and completed the RADAI-F5. An MSUS-trained podiatrist performed multi-planar grayscale (GS) and power Doppler (PD) MSUS assessments on 17 regions of each foot, including joints and soft tissues and evaluated foot disease activity using summated scores based on semi-quantitative grading systems for synovial hypertrophy, PD synovitis, tenosynovitis (0-39) and presence/absence of erosions (0-7). An independent examiner clinically assessed the same 17 regions for swelling and tenderness and scored using a summated score for presence/absence (0-17). The construct validity of the RADAI-F5 was assessed using Spearman’s correlation coefficients with 95% confident intervals (95% CI) to test a priori-specified hypotheses for strength of associations. Results Of 60 participants, 48 were female, with a mean [standard deviation, ± SD] age of 62.6 ± 9.96 and median RA disease duration of 10 (interquartile range 6-20.5) years. For DAS28-ESR disease categories, 10% were in remission, 35% had low disease activity, 18.3% had moderate disease activity, and 36.7% had high disease activity. Forty-three participants were receiving DMARD therapy, and 17 were receiving biologics. Theoretically consistent associations confirming construct validity [95% CI] were observed between the RADAI-F5 and MSUS GS-detected synovial hypertrophy (0.72 [0.57-0.82]; strong) and MSUS PD-detected synovitis (0.50 [0.28-0.67]; moderate), MSUS-detected erosions (0.42 [0.19-0.61]; moderate) and clinical tenderness (0.52 [0.31-0.68]; moderate), and swelling (0.35 [0.11-0.55]; weak). Conclusion Moderate-strong associations between RADAI-F5 and MSUS provide additional evidence of the excellent measurement properties of this tool. The RADAI-F5 scores, as anticipated, were more strongly associated with MSUS-detected synovial hypertrophy compared to clinical examinations of swelling and tenderness. With increased confidence in the RADAI-F5's validity, clinical implementation of the RADAI-F5 could help with the early identification of people with RA who are at risk of poor functional and radiographic outcomes. The RADAI-F5 has the potential for use in a broad range of clinical applications within podiatry and rheumatology, including triage, enhanced multidisciplinary team and patient-clinician communication, and remote consultations. Disclosure A. Hoque: None. M. Steultjens: None. D. Dickson: None. G.J. Hendry: None.

Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic

BackgroundSeven-day clinical pharmacy services in the acute sector of the National Health Service are limited. There is a paucity of evidential patient benefit. This limits investment and infrastructure, despite United Kingdom wide calls.AimTo optimise medicines seven-days a week during surge-2 of the COVID-19 pandemic through implementation of a seven-day clinical pharmacy service. This paper describes service development, evaluation and sustainability.SettingA tertiary-referral teaching hospital, London, United Kingdom.DevelopmentThe seven-day clinical pharmacy service was developed to critical care, acute and general medical patients. Clinical leads developed the service specification and defined priorities, targeting complex patients and transfer of care. Contributing staff were briefed and training materials developed.ImplementationThe service was implemented in January 2021 for 11 weeks. Multidisciplinary team communication brought challenges; strategies were employed to overcome these.EvaluationA prospective observational study was conducted in intervention wards over two weekends in February 2021. 1584 beds were occupied and 602 patients included. 346 interventions were reported and rated; 85.6% had high or moderate impact; 56.7% were time-critical.The proportion of medicines reconciliation within 24-h of admission was analysed across the hospital between November 2020 and May 2021. During implementation, patients admitted Friday-Sunday were more likely to receive medicines reconciliation within 24-h (RR 1.41 (95% CI 1.34–1.47), p < 0.001). Rostered services were delivered sustainably in terms of shift-fill rate and medicines reconciliation outcome.ConclusionSeven-day clinical pharmacy services benefit patient outcome through early medicines reconciliation and intervention. Investment to permanently embed the service was sustained.

Use of Pancreatic Stereotactic Ablative Radiotherapy (PSART) in U.S. Community Cancer Clinics

<h3>Purpose/Objective(s)</h3> Pancreatic stereotactic ablative radiotherapy (PSART) is developing as an alternative to conventional fractionation to improve multi-modal options for care. Guidelines state that PSART should be done in high-volume centers or on trials because of the technical complexity of this procedure risk of causing injury to normal organs. However, patients frequently rely on community radiation centers to access treatment. We audited use of PSART in a group of community-based clinics to examine practice and identify opportunities for advancement. <h3>Materials/Methods</h3> We conducted an IRB approved retrospective analysis of Stereotactic radiotherapy at 123 community-based clinics in the US by querying a prospective in-house record system. Chart review was performed for outcomes. Doses were reported as biologically effective dose (BED) and equivalent dose at 2Gyper fraction (EQD2). Data was analyzed using data management and decision management software. <h3>Results</h3> Among 15,797 patients who were treated with SART from 01/ 2017 to 11/2021, only 119 (0.75%) were PSART of which 42 were palliative. Annual case volume was over time. Motion management was done in 104 (87.4%) of patients. Most patients were treated with either volumetric modulated arc therapy n=90 (75.6%) or helical 3-D CRT and IMRT system n=14(11.8%). Among 77 curative patients, median and modal number of fractions was 5 in 69 (89.6%) of patients (range1-5); commonest BEDs were 32-51.9, 52- 71.9, and 72-91.9 in 28.6%, 35.1%, and 31.2% respectively (range 14.4 - 132); commonest EQD2s were <40, 41-50, and 61-60 in 31.2%, 27.3, %, and 33.8% respectively (range 112 - 110). At median follow up 8.4 months (range 0.3- 50.5) for curative patients, locoregional status was controlled in 34(44.2%), recurrent in 7 (9.1%), and unknown in 36 (46%); 34 (44.2%) were alive, 32(41.6%) had died and 11(14.3%) was unknown. There was a trend for improved survival with BED >= 52 Gy (p=0.08). At median follow up 6.7months (range 1.0- 31) for palliative patients, locoregional status was controlled in 17(40.5%), recurrent in 4 (9.5%) and unknown in 21 (50%); 14 (33.3%) were alive, 22 (52.4%) had died and 6(14.3%) was unknown. Toxicity data reporting was limited. <h3>Conclusion</h3> Rate of PSART practice was low and stable over the five-year period with appropriate technology but wide variation in dose. We have initiated programs to increase access to high-quality PSART: education of community multidisciplinary teams, updated clinical guidelines and dose-constraints, prospective collection of patient-reported outcomes, and investment in technology.

Preparing patients for surgery: Perioperative care and general practice

Perioperative care challenges the integration of community and hospital multidisciplinary teams to prepare patients for surgery from the moment a patient considers undergoing an operation to the later recovery from surgery. Primary care has a role in the perioperative pathway, for example, in the management of long-term conditions and in identifying treatable pathology ahead of surgery. There are many factors beyond the control of primary care that compromise the optimisation of patients’ long-term conditions or even their general health ahead of planned surgery. However, there may be opportunities to optimise patients’ relevant comorbidities when surgery is first contemplated during the increasingly protracted period before surgery. Preoperative assessment clinics (POACs) are integral to perioperative care and present an opportunity to address specific issues relating to the day of surgery and to answer patients’ questions. Often POACs see patients with long-term conditions not optimised for surgery. This is a late, and less than ideal, opportunity to prepare patients for surgery. This article seeks to identify earlier opportunities to effectively improve the preparation of patients for surgery and to avoid postponement of surgery.

Dietitians: roles in the community and contribution to patient care

Dietitians are increasingly working in community roles. Rebecca Gasche explores the ways in which they can contribute to patient care. This article focuses on the main areas in which dietitians can impact patient care, particularly within a community setting, as well as discussing the contribution from dietitians in extended roles and working at advanced practice. A range of research papers and national guidance on dietetic practice are discussed to develop a summative article on the scope of their practice. This article aims to provide insight into the work of dietitians in the community – strengthening the understanding of the roles and to demonstrate how dietetic practice can influence patient care as part of a community multidisciplinary team.

Indeterminate skeletal and lymph node lesion on 18F PSMA 1007 PET/CT scanning: lessons from a review at 12 months with PSMA-RADS.

The study utilizes the prostate-specific membrane antigen-reporting and data system (PSMA-RADS) version 1.0 in a real-world patient scenario in the evaluation of equivocal lesions using the PSMA-RADS categorization for patient management and communication in multidisciplinary team (MDT) meetings. A retrospective analysis of 203 patients who had 18F PSMA PET/CT for either restaging or staging over 12 months was undertaken. The scans were evaluated for local disease, lymph node involvement and distant metastases. The scan findings were classified as suspicious for metastases, and equivocal and benign lesions. Experience with PSMA ligand imaging was considered while classifying the lesions, equivocal lesions were assessed with PSMA-RADS and followed up with complementary imaging and/or clinical follow-up assessment or MDT for further patient management. A total of 91 of 203 patients had equivocal lesions. Follow-up assessment was performed in 47 of 91 patients with imaging ( n = 36) or MDT discussion ( n = 11).On follow-up imaging ( n = 36), equivocal lesion was seen in skeletal lesions ( n = 24), pelvic lymph nodes ( n = 6), both skeletal and pelvic nodes ( n = 4), hilar and mediastinal lymph nodes ( n = 1) and spleen ( n = 1). The patients were reclassified as benign, metastatic with few lesion remained equivocal. Overall follow-up assessment impacted clinical management in 47% patients. 18F PSMA PET/CT may show equivocal lesions; many of them in the skeleton, a small proportion of which are ultimately proven metastatic. In contrast, a higher proportion of the equivocal nodes in the pelvis end up being metastatic on follow-up. A structured reporting with PSMA-RADS grading helps in the proper classification of lesions and standardization of reports.

Dietitians: roles in the community and contribution to patient care.

This article focuses on the main areas in which dietitians can impact patient care, particularly within a community setting, as well as discussing the contribution from dietitians in extended roles and working at advanced practice. A range of research papers and national guidance on dietetic practice are discussed to develop a summative article on the scope of their practice. This article aims to provide insight into the work of dietitians in the community - strengthening the understanding of the roles and to demonstrate how dietetic practice can influence patient care as part of a community multidisciplinary team.

1029 EVEN LIMITED GERIATRICIAN INVOLVEMENT REDUCES LENGTH OF STAY FOR ALL-AGE ACUTE GENERAL SURGERY PATIENTS

Abstract Background More than half of patients undergoing emergency general surgery are older than 651. The Emergency Laparotomy and Frailty (ELF) study identified that frail patients (CFS ≥5) were vulnerable to adverse outcomes and longer hospital stays and should be reviewed by a geriatrician2. The 2021 National Emergency Laparotomy Audit (NELA) found that only 27% were reviewed by a geriatrician1. Local problem A local hospital had no routine geriatrician input to perioperative care of older people admitted under the care of general surgeons. Method/Intervention In one month prior to intervention, we noted CFS recorded once and a geriatrician involved in only 3 patients over the age of 65 (n = 35). We introduced a service comprising twice-weekly geriatrician-led multi-disciplinary team (MDT) meetings of all-age patients followed by selected patient ward rounds. This equated to 2.5 Programmed Activity’s (PA) per week. After another month we measured the number of patients having CFS recorded, those who had geriatrician involvement and length of stay. We also surveyed members of the MDT. Results All 31 patients aged over 65 received geriatrician input with 93.5% having a CFS recorded. Length of stay of all-age patients (n = 75) was reduced from 12.8 to 8.8 days, with the most significant reduction of 6.5 days in over 65’s (16.7 to 10.2); &amp;gt;200 bed days saved for older people. The MDT comments included: ‘improved MDT communication’, ‘early identification of discharge barriers’ and ‘pro-active approach’. Conclusion NELA highlights that consistent geriatrician input remains generally poor. Even a limited geriatrician-led service can be highly effective at guaranteeing review of appropriate patients in line with recommendations from NELA. Alongside targeted patient review geriatricians can support and lead decision making of all-age patients. This cost-effective strategy can reduce length of stay for young and old alike and gained excellent feedback from the MDT.

Hospital organizational structure factors related to discharge planning activities for alcoholics by nurses in Japan.

Nurses play a significant role in providing discharge support for alcoholics. We aimed to explore the organizational structures of hospitals that are related to effective discharge planning activities provided by nurses. We conducted a cross-sectional survey of Japanese hospitals with psychiatric wards that accept alcoholics. The survey questionnaire was administered to one nurse per hospital from August to September 2019. The Discharge Planning Scale for Ward Nurses (DPWN) was used to assess the actual status of the hospital nurse teams' discharge planning activities. The DPWN consists of four subscales: subscale I, "collect information from patients and their families"; subscale II, "supports for decision-making for the patients and families"; subscale III, "utilization of social resources"; and subscale IV, "discharge guidance by cooperating with community support teams and multidisciplinary teams." From the valid responses of 116 hospitals, scores on subscale IV were significantly lower than scores on subscales I, II, and III, indicating that medical care guidance through multidisciplinary collaboration between hospitals and the community was inadequate. In addition, multiple regression analysis showed that "hospital management and administrators understanding about nurses' discharge support activities," and "planning discharge schedules, such as using clinical paths" were significantly and independently related to the total DPWN and each of subscale scores, regardless of the hospital's establishment body and size. "Multidisciplinary discharge support" was significantly related to subscale II. These findings have implications for the management of discharge planning activities provided by nurses for alcoholics through multidisciplinary collaboration.

Impact of simulation training for teamwork and communication intervention on patient safety in the emergency department

Background: The emergency department (ED) is the hospital division that is most vulnerable to poor communication and teamwork-based medical errors that affect patient safety. One approach to prevent medical errors is by training and assessing healthcare workers using simulation-based (SB) teamwork and communication training. This study aimed to explore the extent to which SB training could improve teamwork and communication and reduce preventable medical errors in the ED. Method: The study was conducted at the Ministry of National Guard Health Affairs, a tertiary care center with a 39-bed ED, in Saudi Arabia. A total of 123 ED healthcare staff participated in the study. This study adopted a single-subject experimental design with the intervention of simulation training in ED cases. The methodology focused on three domains: 1) patient safety in the ED, 2) inter-professional and multidisciplinary simulation team training, and 3) team dynamic enhancement use. Staff perceptions regarding teamwork and communication pre-and post-intervention and the relationship between changes in their perception of performance in the ED and patient outcomes. The chi-square test was used for univariate analysis, and a generalized linear regression model was adjusted for demographics in multivariate analysis. Results: Staff perceptions were collected from all multidisciplinary team members before and after simulation training. The data revealed a significant improvement in overall staff perceptions toward teamwork and communication (8% to 34%, p-value = 0.001). Conclusion: SB communication and teamwork training in the ED resulted in a sustained and measurable improvement in ED staff perceptions toward teamwork and communication. The results suggest that simulation sessions may improve staff perceptions and multidisciplinary team communication during critical situations in the ED.

1702 A Proforma To Improve Documentation of Surgical Ward Rounds

Abstract Aim The ward round is an important vehicle in the care of surgical inpatients. Good quality documentation is essential in recording patient progress over time and communicating clearly between multidisciplinary team (MDT) members. This quality improvement project aimed to implement a standardised proforma to improve the quality of ward round documentation, improving MDT communication and patient safety. Method Ward round entries from an elective surgical unit at a District General Hospital were retrospectively reviewed using a fifteen-item checklist to assess quality of documentation. These criteria were divided into: A re-audit was performed following introduction of a ward round proforma using the same criteria. Results The pre-intervention arm included 41 entries and the post-intervention arm included 27 entries. Improvements were seen in twelve of the fifteen criteria assessed. The greatest improvements were seen in documentation of management plans; documentation of discharge plan improved from 58.5% to 100%, VTE prophylaxis from 42% to 100% and drain/ catheter plan from 42 to 93%. Documentation of two criteria (signature and bleep) decreased and documentation of date remained at 100%. Conclusions The use of a standardised proforma improves documentation of surgical ward rounds, particularly patient’s’ onward management plans. Further modifications to the proforma could aim to improve documentation of bleep and signature.

Critical Success Factors for Addressing Discharge Inefficiency at a Large Academic Medical Center: A Lean Six Sigma Approach.

Delayed discharges can be a systemic issue. Understanding the systemic factors that contribute to discharge inefficiencies is essential to addressing discharge inefficiencies. This article reports on a Lean Six Sigma approach and the process to identifying inefficiencies and systemic barriers to early discharge in a large US academic medical center. A qualitative methodology guided this project. In particular, direct observation methods were used to help the project team identify factors contributing to discharge inefficiencies. Overall, findings suggest that establishing consistent multidisciplinary team communication processes was a contributing factor to reducing the inefficiencies around discharges. On a more granular level, key barriers included disparate communication systems, disruptors (specifically Kaizen bursts), and unique role challenges. This article provides a framework for addressing discharge inefficiencies. Because the output of the process, a critical contributor to the overall outcome, is often not analyzed, this analysis provides value to others contemplating the same or similar process toward discharge efficiency.

'It takes a village': a qualitative study on malnutrition and oral nutritional supplements with older adults in Ireland.

Malnutrition affects approximately 20% of older adult populations in Europe, yet their views on the condition are rarely explored. This qualitative study aimed to explore the experiences of older adults living with malnutrition and prescribed oral nutritional supplements in the community setting. Semi-structured individual interviews were used to collect data from 13 community-dwelling individuals aged ≥60 years with a current or previous prescription for oral nutritional supplements. Self-perceived health status was measured using the EuroQol EQ-5D-5L, a short questionnaire and visual analogue scale. Interviews were audio-recorded and transcribed verbatim. Interview data were organized using NVivo 12 and analyzed using inductive thematic analysis. Median age was 80.0 (interquartile range 19.5) years, seven were male and six were female. Median health score was 60.0 (interquartile range 35.0) out of 100. Almost one-third reported severe or extreme problems with usual activities, and pain or discomfort. One main theme was identified from the interviews: 'It takes a village', with four subthemes (i) 'I get by with a little help from my friends', (ii) 'The obvious diagnosis', (iii) 'The missing T in MDT' and (iv) 'Confusion'. Participants with malnutrition reported relying on friends, family and carers with poor multidisciplinary team communication and lack of dietetic support. Participants in this study experienced poor management of malnutrition with missing links between the hospital and community healthcare settings, and lack of dietetic services. Patient views should be used to inform public health guidelines and guide future interventions in the community to improve the health status of older adults with malnutrition.