Multidisciplinary Ward Rounds Research Articles

Introducing multidisciplinary ward rounds in Malawi: a best practice implementation project.

The Royal College of Physicians (RCP) and the Royal College of Nursing (RCN) in the United Kingdom advocate the use of structured multidisciplinary team (MDT) ward rounds since they can enable safe, effective, improved care and enhanced staff satisfaction. This project sought to implement best practices for MDT ward rounds in a male medical ward in a hospital in Malawi. The project was conducted in line with the JBI Evidence Implementation Framework. A baseline audit of MDT ward rounds was conducted with six staff members. Audit criteria consisted of ten best practices, as recommended by JBI, the RCP, and the RCN. Stakeholder meetings were held to review the baseline audit results and highlight areas of non-compliance. JBI's Getting Research into Practice (GRiP) tool was used to identify barriers to compliance with best practices, and a follow-up audit was conducted to determine changes in practice. The results only showed improvement for one criterion, which rose from 33% to 100% (n=6) where nurses attended the ward round. This study demonstrated some challenges in evidence implementation projects and how these can, in part, be overcome. While the results only demonstrated improvement for one criterion, this paper shows how audits can be used to promote best practice, which in this case resulted in nurses being more involved in ward rounds, improvements in MDT communication, enhanced nurse inclusion in decision-making and, consequently, patient care. http://links.lww.com/IJEBH/A233.

Nurses’ absence in multidisciplinary ward rounds: Reasons and solutions

The Article Abstract is not available.

Removal of incorrect penicillin allergy labels in a UK hospital

ObjectivesPenicillin allergy records are common, often incorrect and are associated with broad spectrum antibiotic use. We piloted a pharmacist-led multidisciplinary penicillin allergy de-labelling daily ward round to determine the opportunity for penicillin allergy de-labelling in a UK hospital. MethodsA daily ward round, delivered by antibiotic pharmacists or junior doctors, identified adult medical and surgical patients between 7 November 2022 and 31 January 2023 with a penicillin allergy record that was preventing first-line penicillin use. An allergy history was taken before risk stratifying likelihood of future harm from penicillin re-exposure and an allergy testing method was determined (direct de-label on history alone or after direct drug provocation testing). After successful allergy de-label, the antibiotic was switched to a penicillin antibiotic. ResultsOf 7214 inpatients during the study period, 1133 (15.7%) had a penicillin allergy record. Of 285 allergy histories taken, 105 (36.8%) met high-risk criteria, 45 (15.8%) met low-risk criteria eligible for direct de-label and 73 (25.6%) met criteria eligible for direct drug provocation testing. We were unable to obtain a history for 61 (21.4%) patients. Of 45 low-risk patients eligible for direct de-label, 40 (88.9%) were de-labelled of whom 24 (53.3%) were switched to a penicillin antibiotic. Of 73 patients with a low-risk allergy history eligible for direct drug provocation testing, 16 (21.9%) received direct drug provocation testing, of whom 9 were switched to a penicillin antibiotic. Two direct de-label patients experienced harm (thrush within 5 days and delayed skin reaction after day 5); none of the direct drug provocation testing patients had a reaction by day 5. The switches resulted in reduced alternative antibiotic use by 173 Daily Defined Doses (DDDs). DiscussionPenicillin allergy de-labelling patient pathway delivered by pharmacists and junior doctors was safe and effective and well accepted by patients and the wider clinical teams.

‘An equal seat at the table’: Service users’ experiences of ward rounds in secure care, through the lens of trauma-informed care principles

This evaluation aimed to explore the views of service users attending a fortnightly, multidisciplinary ward round meeting on a forensic mental health low secure unit (LSU). The focus was on identifying the ways in which the ward round experience embodied trauma informed care principles. The need for implementing models of trauma informed care has been widely recognised within mental health services. Previous research has demonstrated the negative impact of ward rounds on service user experiences, suggesting a need for change. This evaluation used a focus group followed by semi-structured interviews constructed through the lens of five principles associated with a trauma-informed care approach. Six service users participated in the service evaluation. Interviews were interpreted qualitatively using thematic analysis. Six core themes were identified and are discussed in relation to their application to clinical practice. The themes suggest improvements are required for ward rounds to have a positive impact on service users and promotes the necessity for services to hold collaboration, choice, empowerment, trust and safety in high regard as key principles in embedded ward processes that aim to support recovery.

The delivery of obstetric anaesthetic care in UK maternity units: a survey of practice in 2021

BackgroundAnaesthetists are crucial members of the maternity unit team, providing peri-operative analgesia and anaesthesia, and supporting the delivery of medical care to high-risk women. The effective contribution from obstetric anaesthetists to safety in maternity units depends on how anaesthesia services are organised and resourced. There is a lack of information on how obstetric anaesthetic care is resourced in the UK. MethodsThe Obstetric Anaesthetists’ Association surveyed UK clinical leads for their hospital’s obstetric anaesthetic service and examined compliance with national recommendations. ResultsThere were 153 responses by lead obstetric anaesthetists from 184 maternity units in the UK (83%). The number of consultants per 1000 deliveries was 2.2 [1.6–2.7] (median [IQR]). In 20% of units, there was a dedicated on-call rota (on-call only for obstetric anaesthesia), whilst the remainder had a ‘combined’ on-call rota (on-call for other clinical areas in addition to obstetrics). Multidisciplinary ward rounds were held in 83% of units. Twenty-five (16%) units reported having no regular multidisciplinary ward rounds, of which nine (6%) did not have any multidisciplinary ward rounds. Planned operating lists for elective caesarean sections were provided in 77% of units. ConclusionsIn the largest survey of obstetric anaesthesia workload to be reported for any health system, we found significant disparities between obstetric anaesthesia service provision and current national recommendations for areas including consultant staffing, support for elective caesarean section lists, antenatal anaesthetic clinics, and consultant support for service development. Wide national variation in service provision was identified.

Experiences of health care professionals in intensive care when families participate in clinician handovers: a qualitative systematic review protocol

This review will evaluate the experiences of health care professionals in the intensive care unit when families participate in clinician handovers. Families of patients admitted to the intensive care unit report stress and anxiety. Family participation in multidisciplinary rounds in the intensive care unit may improve patient and family outcomes. However, health care professionals have different attitudes toward family participation. Furthermore, there is limited understanding of the barriers, facilitators, and other outcomes of family participation in clinician handovers for the patient, family, and health care professionals. The review will consider studies involving health care professionals (eg, nurses, physicians, allied health professionals) and any type of family participation, from bedside presence to participation in decision-making. Clinician handovers may be multidisciplinary ward rounds or nursing handovers. Settings may be the adult, pediatric, or neonatal intensive care unit in rural or metropolitan regions in any country. Studies in other clinical contexts will be excluded. Databases to be searched include CINAHL, MEDLINE, Scopus, PsycINFO, Embase, Emcare, Web of Science, and ProQuest Central. The search will be limited to articles written in English from 2000 to the present. Two independent reviewers will screen titles and abstracts, assess the full text of selected citations for inclusion, and assess methodological quality. A data extraction tool will be used, and findings will be assigned a level of credibility. Meta-aggregation will be used to synthesize findings. Disagreements between reviewers will be discussed to reach consensus; a third reviewer will be consulted if necessary. PROSPERO CRD42020223011.

Impact of pharmacist intervention in antibiotic stewardship programmes for critically ill neonates: A systematic review and meta-analysis.

Antibiotic stewardship programmes (ASPs) are introduced to ensure effective antibiotic use. Pharmacists can be involved in ASPs to facilitate the appropriate antibiotic use. Prolonged use of antibiotics causes adverse events in critically ill neonates. Hence, this systematic review and meta-analysis was aimed at investigating pharmacists' functions in ASPs in critically ill neonates and the effect of ASP implementation on antibiotic use. A comprehensive search of PubMed/Medline, Embase, and Cochrane Library databases until January 2021 was conducted and studies that reported the functions of pharmacists in ASPs for critically ill neonates and the results of ASP implementation were included in this review. All processes were performed by two reviewers independently, and any discordance between the two was resolved by discussion. In all, 19studies were included in this review. Pharmacists were found to have various functions in ASPs, such as participating in the development of antibiotic use guidelines, auditing antibiotic prescriptions, participating in multidisciplinary ward rounds, educating other ASP team members, checking blood culture or laboratory data, and monitoring antibiotic use. A meta-analysis revealed that ASP implementation in critically ill neonates was significantly associated with a 23% reduction in the overall antibiotic use rate (ratio of means: 0.77, 95% confidence interval: 0.69-0.87, p<0.001). Moreover, the overall duration of antibiotic therapy significantly reduced by 15% with ASP implementation (ratio of means: 0.85, 95% confidence interval: 0.78-0.91, p<0.001). The implementation of ASPs involving pharmacists, especially in critically ill neonates, was associated with the reduced use and duration of antibiotic treatment. Thus, pharmacists played a key role in ASPs in critically ill neonates.

Pivot to online learning for adapting or continuing workplace-based clinical learning in medical education following the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 70

Background The novel coronavirus disease was declared a pandemic in March 2020, which necessitated adaptations to medical education. This systematic review synthesises published reports of medical educational developments and innovations that pivot to online learning from workplace-based clinical learning in response to the pandemic. The objectives were to synthesise what adaptations/innovation were implemented (description), their impact (justification), and ‘how’ and ‘why’ these were selected (explanation and rationale). Methods The authors systematically searched four online databases up to December 21, 2020. Two authors independently screened titles, abstracts and full-texts, performed data extraction, and assessed the risk of bias. Our findings are reported in alignment with the STORIES (STructured apprOach to the Reporting in healthcare education of Evidence Synthesis) statement and BEME guidance. Results Fifty-five articles were included. Most were from North America (n = 40), and nearly 70% focused on undergraduate medical education (UGME). Key developments were rapid shifts from workplace-based learning to virtual spaces, including online electives, telesimulation, telehealth, radiology, and pathology image repositories, live-streaming or pre-recorded videos of surgical procedures, stepping up of medical students to support clinical services, remote adaptations for clinical visits, multidisciplinary team meetings and ward rounds. Challenges included lack of personal interactions, lack of standardised telemedicine curricula and need for faculty time, technical resources, and devices. Assessment of risk of bias revealed poor reporting of underpinning theory, resources, setting, educational methods, and content. Conclusions This review highlights the response of medical educators in deploying adaptations and innovations. Whilst few are new, the complexity, concomitant use of multiple methods and the specific pragmatic choices of educators offers useful insight to clinical teachers who wish to deploy such methods within their own practice. Future works that offer more specific details to allow replication and understanding of conceptual underpinnings are likely to justify an update to this review.

Clinical pharmacy services provided in public sector hospitals in Nigeria: a national survey.

Studies show that clinical pharmacy services are effective in optimizing medicines use and patients' outcomes. This study aimed to determine the clinical pharmacy services provided in public sector hospitals in Nigeria. This was an online survey of 296 primary, secondary and tertiary care hospitals sampled purposively across the 36 States and Federal Capital Territory in Nigeria. Data analysis was conducted descriptively via χ 2 test and multivariate analysis of variance (MANOVA). Responses were obtained from 272 hospitals in the country with a survey completion rate of 88%. This included 55 tertiary, 72 secondary and 145 primary healthcare centres (PHCs). Pharmacists provided pharmaceutical care services in all the tertiary care hospitals, 94% of the secondary and in only 6% of the PHCs surveyed. Most of the secondary and tertiary care hospitals provided medicines information, patient education and counselling, and in-patient dispensing services [n = 97 (79%), 116 (94%), 88 (72%)], respectively. However, fewer than a third reported involvement in multidisciplinary ward rounds, medication chart review and antibiotic stewardship programmes [n = 18 (15%), 33 (27%), 22 (18%), respectively]. Furthermore, medication error reporting and pharmacovigilance services were each routinely provided in only about half of the secondary and tertiary care hospitals [n = 62 (50%)], and this was not associated with the level of care (P > 0.05). The findings of this study demonstrate disparity in clinical pharmacy service availability across the various levels of care in Nigeria and emphasize the need to prioritize their integration within the primary care sector.

Barriers for nurse participation in multidisciplinary ward rounds: An integrative review

Background &amp; Aim: The purpose of this integrative literature review was to find, critically evaluate, and describe publications about barriers against nurse participation and collaboration in multidisciplinary ward rounds. Although multidisciplinary ward rounds are the right place for doctors and nurses to communicate, nurses’ attendance in these rounds is missed. The nurses' absence at the multidisciplinary ward rounding has negative effects on the patients, their relatives, other team members, and their care.&#x0D; Methods: A systematic approach to searching, screening, and analyzing the literature was applied. The original and review papers were used. This study was an integrative review based on Whittemore and Knafl’s framework. Web of Science, PubMed, Scopus, Cochrane, Magiran, and SID were searched by time limitation for ten years (2009-2019). The search was conducted between February 2019–March 2019. The language was limited to English and Persian.&#x0D; Results: After duplicate removal, title, and abstract review, 63 papers remained. After full-text control, finally, 7 papers chased for this review. Barriers for rounding were divided into 4 main categories: time limitation, reluctance to participate, ineffective communication, and infrastructure and administration. Nurse time limitation, feeling not being valued by medicines, lack of standard and structure, and nurse unawareness from time of round are the most repeated barriers. &#x0D; Conclusion: Barriers may need to be removed until nurse participation in multidisciplinary ward rounds improves. Some study needs to take place about this issue in Iran to identify the situation, facilitators, and barriers specific to our country. Based on them, a relevant intervention can be chased.&#x0D;

Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference?

BackgroundProximal femoral fractures are a major socioeconomic burden and they occur mainly in geriatric patients. High mortality and complication rates are reported. To reduce the mortality and morbidity of these patients, co-management with geriatricians has been recommended. Most previous studies have focused on relatively comprehensive care models. Models with only a few additions to the usual care have not been extensively evaluated.MethodsThis retrospective observational study included all patients aged ≥70 years (mean age: 84.5 ± 7.1 years, 70% women) with an isolated proximal femoral fracture treated surgically in our institution from May 2018 to October 2019. In the first 9 months, patients were treated with the usual care (control group, n = 103). In the second 9 months, patients were treated with our multidisciplinary care model (intervention group, n = 104), which included the usual care, plus: (1) one multidisciplinary ward round per week and (2) one “elective” operation slot per day reserved for proximal femoral fractures. Baseline characteristics and outcome measures of the hospital stay were extracted from electronic health records. A 3-month follow-up was conducted by phone.ResultsBaseline characteristics were comparable between groups (p > 0.05). The hospital stay was shorter in the intervention group than in the control group (7.8 ± 4.3 vs. 9.1 ± 4.5; p = 0.022). The intervention reduced the waiting time for surgery by more than 10 h (intervention: 25.4 ± 24.5 vs. control: 35.8 ± 34.1 h; p = 0.013). A structured phone interview was not performed in 30.9% of the cases. The model reduced the overall dissatisfaction rate by more than half (12.9% vs. 32.4%; p = 0.008). On the other hand, the groups had similar perioperative complication rates (25% vs. 24.3%; p > 0.9999) and mortality (4.8% vs. 3.9%; p > 0.9999) and they remained similar at the 3-month follow-up (complications: 20.3% vs. 17.6% p = 0.831, mortality: 18.2% vs. 15.0% p = 0.573).ConclusionWe found that two additions to the usual proximal femoral fracture regimen could significantly improve the overall satisfaction rate, reduce the length of hospital stay and shorten the waiting time for surgery. In contrast to previous studies, we observed no significant improvements in complication or mortality rates. Further changes in the standard care might be needed for this purpose.

Is ward round participation by clinical pharmacists a valuable use of time and money? A time and motion study.

While the benefits of multidisciplinary ward round (WR) participation by clinical pharmacists have been demonstrated, it can be time-consuming. No previous studies have compared the specific benefits of WR participation and other clinical activities. To assess the clinical impact of different clinical pharmacist activities and analyse patterns of practice based on WR involvement and timing and significance of clinical interventions. In a prospective, observational time and motion study, clinical pharmacists servicing 6 unmatched specialty areas in a major quaternary public hospital were observed and their activities documented. Pharmacists' self-recorded interventions underwent expert panel assessment for significance and potential cost savings. Workflows and interventions were analysed for the 4 pharmacists involved in WRs ('WR pharmacists') during their time 'on' and 'off' rounds and for 2 pharmacists not involved in WRs ('non-WR pharmacists') using chi-square analyses. During 170 h of observation, 267 clinical interventions (53.9% minor, 40.1% moderate, 6.0% major) were recorded. WR pharmacists spent 24.3% of their time on rounds, and 64.8% of interventions were made during this time (intervention rates: 4.5/hour on WR vs. 0.8/hour off WR vs. 1.3/hour for non-WR pharmacists). Differences in WR and non-WR pharmacists' workflows were observed, although there was no difference in time spent on clinical/patient-centred activities (p = 0.70). WR involvement was associated with significantly quicker interventions (p < 0.001). All major interventions were made by WR pharmacists; 80% were made on rounds. Major interventions were estimated to have decreased lengths of stay, intensive care requirements and procedure costs. Clinical pharmacists focussed on patient-centred activities, regardless of WR involvement. Notwithstanding differences in the WR and non-WR specialty areas, WR participation was associated with more significant and timely interventions and potential cost savings. Coupled with the subjective benefits of WR participation observed, these findings support the potential value of clinical pharmacist WR participation.

Enhancing care of patients requiring a tracheostomy: A sustained quality improvement project

IntroductionWithin the UK approximately 5000 surgical and 12,000 percutaneous tracheostomies are performed annually. Whilst an essential component of patient care, the presence of a tracheostomy is not without concern. Landmark papers have demonstrated recurrent themes related to the provision of training, staff and equipment, leading to avoidable patient harm, life-altering morbidity and mortality. The development of the Global Tracheostomy Collaborative (GTC) and the Improving Tracheostomy Care (ITC) project have provided the necessary infrastructure to make improvements, with individual organizations responsible for its implementation. MethodThis quality improvement project, funded by the NHS Wales Critical Care and Trauma Network, developed a dedicated tracheostomy team to improve the quality of care provided to those patients requiring a tracheostomy through staff education, equipment standardisation and multidisciplinary tracheostomy ward rounds. Global Tracheostomy membership was funded through involvement in the ITC project. ResultsFormal tracheostomy teaching was delivered by the tracheostomy team to 165 clinicians involved in tracheostomy care. Improvements in self-assessed confidence with knowledge and were observed for all aspects of tracheostomy care. Standardisation and centralisation resulted in reduction in waste and unnecessary variation. Compliance with ‘emergency tracheostomy blue box’ availability with an increase from 5% to 100%.Comparison of data from the QI period against baseline data, demonstrated improvement in rates of decannulation, and non-significant improvements in time to decannulation, critical care and hospital length of stay. Additionally, there were associated reductions in adverse events. ConclusionThis QI project, supported by involvement with the GTC and ITC, resulted in reductions in adverse events, improved patient safety, non-significant reduction in time to achieve weaning milestones and a reduction in hospital length of stay.

Characteristic of drug-related problems and pharmacists' interventions in a stroke unit in Thailand.

Background Little information is available regarding pharmacist's intervention to solve drug-related problems (DRPs) in a stroke unit. Objective To investigate the nature and frequency of DRPs along with the role of pharmacists in a stroke unit. Setting The study was conducted at the stroke unit of Siriraj hospital, a university affiliated tertiary care hospital in Thailand. Method A retrospective descriptive study of DRPs and pharmacists' interventions for stroke patients was performed during July 2015 to December 2016. Data were collected from patient's medical records and pharmacist's intervention record forms. DRPs were categorized using the Hepler-Strand classification. The stroke pharmacist team, consisting of a board-certified pharmacotherapy specialist, neurology pharmacy residents and stroke unit pharmacists, participated in the multidisciplinary ward round in the stroke unit 5days a week. All patients were visited by a member of the stroke pharmacist team within the first two days of their admission to conduct a thorough review of drug therapy for every patient and provided appropriate recommendation to the multidisciplinary team either verbally during the ward round or with written information in the patients' medical charts, as appropriate. Main Outcome Measure (a) incidence and characteristics of DRPs (b) types and the acceptance of pharmacists' interventions. Results A total of 859 patients were admitted, of those, 768 patients had ≥ 1 DRPs and a total of 796 DRPs were identified. Clinical pharmacists provided 659 interventions to the multidisciplinary team. The most common DRPs identified were "untreated indications" (22.6%) and "non-compliance" (21.0%). Of all DRPs, 74.6% were stroke related issues. The most implicated drugs were antihypertensive drugs, followed by antithrombotic therapies. The multidisciplinary team accepted 84.7% of pharmacists' interventions. Conclusion DRP in a stroke unit is common. Clinical pharmacists in a stroke unit can effectively reduce and prevent DRPs with the focus on performing medication reconciliation, providing recommendation on dosage adjustment and proper drug selection for stroke patients.

Feasibility of Antimicrobial Stewardship (AMS) in Critical Care Settings: A Multidisciplinary Approach Strategy.

Antimicrobial resistance is escalating and triggers clinical decision-making challenges when treating infections in patients admitted to intensive care units (ICU). Antimicrobial stewardship (AMS) may help combat this problem, but it can be difficult to implement in critical care settings. The implementation of multidisciplinary AMS in ICUs could be more challenging than what is currently suggested in the literature. Our main goal was to analyze the reduction in duration of treatment (DOT) for the most commonly used antibacterial and antifungal agents during the first six months of 2014, and during the same period two years later (2016). A total of 426 and 424 patient encounters, respectively, were documented and collected from the intensive care unit’s electronic patient record system. Daily multidisciplinary ward rounds were conducted for approximately 30–40 min, with the goal of optimizing antimicrobial therapy in order to analyze the feasibility of implementing AMS. The only antimicrobial agent which showed a significant reduction in the number of prescriptions and in the duration of treatment during the second audit was vancomycin, while linezolid showed an increase in the number of prescriptions with no significant prolongation of the duration of treatment. A trend of reduction was also seen in the DOT for co-amoxiclavulanate and in the number of prescriptions of anidulafungin without any corresponding increases being observed for other broad-spectrum anti-infective agents (p-values of 0.07 and 0.05, respectively).

Improving tracheostomy care: collaborative national consensus and prioritisation of quality improvements in the United Kingdom

Background Tracheostomies are artificial airway devices used predominantly to manage airway obstruction and to facilitate weaning from prolonged mechanical ventilation. Whilst a lifesaving procedure, tracheostomy can also lead to significant morbidity and mortality. Associated vocalization and swallowing problems lead to anxiety for patients, families and healthcare staff. The Global Tracheostomy (Quality Improvement) Collaborative can improve the safety and quality of care in participating institutions, leading to a large-scale UK-wide evaluation. However, whilst individual strategies have proved effective in single centres, it is unclear which tracheostomy quality improvement program elements should be prioritized in the UK’s National Health Service’s (NHS) diverse hospitals. Aims Through a unique consensus and prioritisation exercise using front line staff and leaders from 20 participating UK hospitals, we aimed to develop a national strategy for tracheostomy quality improvements. Methods Following national research ethics committee approval, representative multidisciplinary staff groups were interviewed and completed bespoke questionnaires regarding their experiences of tracheostomy care and associated quality improvements. Qualitative evaluation techniques were applied to develop key themes, further refined by group consensus and prioritisation exercises, creating a ranked list of important quality improvement interventions that should be implemented. Results Thematic analysis yielded 22 statements regarding tracheostomy care. Highly ranked priority interventions included multidisciplinary staff education, standards and competencies, multidisciplinary ward rounds, equipment standardisation and structured care bundles. Conclusion Prioritising distinct quality improvement interventions will allow providers to focus on improving the quality and safety of tracheostomy care using resources and strategies that are important to frontline healthcare staff.

RECALMIN: The association between management of Spanish National Health Service Internal Medical Units and health outcomes.

To investigate the association between management of Internal Medical Units (IMUs) with outcomes (mortality and length of stay) within the Spanish National Health Service. Data on management were obtained from a descriptive transversal study performed among IMUs of the acute hospitals. Outcome indicators were taken from an administrative database of all hospital discharges from the IMUs. Spanish National Health Service. One hundred and twenty-four acute general hospitals with available data of management and outcomes (401 424 discharges). IMU risk standardized mortality rates were calculated using a multilevel model adjusted by Charlson Index. Risk standardized myocardial infarction and heart failure mortality rates were calculated using specific multilevel models. Length of stay was adjusted by complexity. Greater hospital complexity was associated with longer average length of stays (r: 0.42; P < 0.001). Crude in-hospital mortality rates were higher at larger hospitals, but no significant differences were found when mortality was risk adjusted. There was an association between nurse workload with mortality rate for selected conditions (r: 0.25; P = 0.009). Safety committee and multidisciplinary ward rounds were also associated with outcomes. We have not found any association between complexity and intra-hospital mortality. There is an association between some management indicators with intra-hospital mortality and the length of stay. Better disease-specific outcomes adjustments and a larger number of IMUs in the sample may provide more insights about the association between management of IMUs with healthcare outcomes.

Evaluating the quality improvement impact of the Global Tracheostomy Collaborative in four diverse NHS hospitals

Tracheostomies are predominantly used in Head & Neck Surgery and the critically ill. The needs of these complex patients frequently cross traditional speciality working boundaries and locations and any resulting...

CLINICAL SUPERVISION – WHAT ABOUT THE SPECIALIST TRAINEES?

IntroductionClinical supervision is defined by Barber and Norman as having four main functions: educational, supportive, managerial and development of self-awareness.1It is common practice within initial pharmacy education for clinical supervision...

Evaluation of the effect of teaching rounds of the multidisciplinary joint radiotherapy department

Objective To explore the effect of the joint teaching rounds of the multidisciplinary radio-therapy. Methods 54 clinical college students of Grade 2013 was selected as the control group, adopting the traditional single teaching ward round model, while 58 clinical college students of Grade 2014 was se-lected as the research group, adopting the multidisciplinary joint radiation operation mode. By contrasting the satisfaction questionnaire, calculating and delineating the target volume error rate and the theory exami-nation results, the effect of teaching ward round was evaluated. Results ①According to the survey, the research group’s satisfaction in teaching methods, stimulating students' enthusiasm for learning, improving their clinical thinking ability and consolidating the knowledge (respectively 91.38%, 86.21%, 82.76%, 93.10%), was higher than that of the control group (75.93%, 68.52%, 62.96%, 77.78%), and the difference was statistically significant (chi square values were 4.95 5.05, 6.25, 5.36; P<0.05). ②The research group’s pass rate in delineation of Gross Target Volume (GTV) and the Clinical Target Volume (CTV) was (82.76%, 86.21%), higher than that of the control group (53.70%, 62.96%), and the difference was statistically signifi-cant (chi square values were 14.36, 9.48; P<0.01). ③Research group’s score in clinical Three Basics and oncology theory achievement was(88.75±5.23) and (82.72±3.69), higher than the control group [(81.88±613), (80.74±3.25) points], and the difference was statistically significant (t=6.40 respectively, 3.01; P< 0.05). Conclusion Radiotherapy department’s multi-disciplinary joint ward round helps to improve the teaching quality. Key words: Multiple disciplines; Joint rounds; Radiotherapy department