Improving the weekend spinal ward round at a major trauma centre.

BACKGROUND/AIMS: Documentation is key for communicating between members of the multidisciplinary team, allowing for better care, but documentation for spinal patients in the authors' centre was poor. METHODS: Every ward round encounter was analysed for six weekends. Data were analysed and presented to the department. A weekend ward round proforma was designed to help improve ward-round documentation. Ward round entries were then re-audited over four weekends to assess the usefulness of the new proforma. RESULTS: A total of 69 patient encounters were analysed in cycle 1, 58 in cycle 2 and 92 in cycle 3. In cycle 1, 80% of encounters had inadequate documentation. Following introduction of the ward round proforma there was a significant improvement in documentation in six out of fields, which was maintained in four out of seven fields 2 years later. CONCLUSIONS: The authors believe that this improvement may avoid adverse effects on patient care, streamline doctors' time and reduce medicolegal consequences.

Improving the accuracy of digital templating: achieving success through stakeholder management.

The use of a marker ball in digital templating for hip arthroplasty is a well-established method of preoperative planning and is used to overcome the inherent magnification in plain film radiographs. Our hospital policy is to place a marker ball in all anteroposterior pelvic films taken in the emergency department (ED) which have been requested for suspected neck of femur fractures. We carried out a baseline measurement followed by three Plan-Do-Study-Act cycles for all pelvic films taken in ED during July 2016, November 2016, February 2017 and November 2017. Interventions between the baseline measurement and cycle 1 were to educate the lead radiographer and publish the results in the radiology newsletter, and between cycles 1 and 2 was to run a teaching session for radiographers, display posters in the X-ray department and place an electronic prompt on the X-ray machine to alert them of the need to place a marker ball in the X-ray field. Cycle 3 looked to see if improvements were sustained. 16/81 (20%) radiographs complied with the policy in our baseline measurement; 25/51 (46%, p=0.002) in cycle 1; 40/54 (74%, p=0.0056) in cycle 2; and 48/63 (76%) in cycle 3. Our quality improvement project led to large improvements in clinical practice through straightforward, small, but appropriately targeted interventions. Stakeholder management is key to successfully implementing change. The next step is to switch from the VoyantMark to the KingMark marker ball, as it has greater accuracy of templating and is also easier to place within the field of an X-ray.