Surgical ward rounds “quality” correlates with outcomes, complications

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1. Surgical ward round quality was highly variable, ranging from 9% to 91% of sources of clinical information assessed. 

2. Patients assessed with low-quality surgical ward rounds had higher incidence of preventable complications or complications due to suboptimal care. 

Evidence Rating Level: 2 (Good)       

Study Rundown: Surgical techniques have greatly improved in the past several decades, and patient safety and outcomes have vastly improved. However, the majority of adverse events occur on the ward rather than in the operating room, and improvements on ward rounds have been slower. This study investigated whether the quality of surgical ward rounds affects clinical outcomes. It was demonstrated that lower quality surgical ward rounds correlated to more preventable complications and suboptimal care. The study was limited in that the method of rating ward round quality was unclear. It was not stated whether or not the ward team was aware of being observed and rated. There was also no discussion of who was assessing the ward rounds, and assessments were done by a single observer. Thus, inter-rater reliability and possible Hawthorne effect could not be calculated. Moreover, the rating was assigned by a single observer at a single point in time, which may not be representative of overall quality.

Click to read the study in Annals of Surgery

Relevant Reading:Patient Safety in Surgery

In-Depth [prospective cohort study]: This study examined 50 patients admitted to the general surgery high-dependency unit (HDU), which is similar to a surgical ICU, at an academic tertiary center in London, England. A total of 69 patient ward rounds were observed. Ward rounds were assessed based on thoroughness of patient evaluation as determined by percentage of sources of clinical information (SCI) considered. Nontechnical skill performance was assessed by the W-NOTECHS score, a validated scale assessing teamwork, communication, and leadership skills. Patient outcomes were assessed by case note review of records upon discharge, and recorded on an intention to treat basis. Ward round quality, as measured by percentage of SCI assessed, varied from 9% to 91% (mean=55%, SD=17%), and W-NOTECHS scores varied from 16 to 25 (mean=19.7, SD=0.35). 41% of complications were determined to be a result of suboptimal patient assessment, likely resulting in delayed diagnosis and treatment. Patients assessed by low-quality ward rounds (% SCI less than mean) had a higher incidence of preventable complications and suboptimal treatment than patients assessed by high-quality ward rounds (83% vs 39%, P=0.034).

By James Jiang and Allen Ho

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