Editor – I read with great interest Herring et al's professional issues paper (Clin Med Feb 2011 pp 20–2) on ward rounds and using a checklist to improve quality and safety. In the modern NHS, there is often significant pressure on consultant staff to consolidate several clinical duties during their clinical sessions. As our population is aging and people are living longer than ever before, the majority of patients in medical wards are now elderly with multiple medical issues and also social issues. This obviously creates complexity in ward rounds.
From our experience, cardiology ward rounds can be divided into many facets. A few examples are as follows: a) consultant-led ward round; b) specialist registrar (SpR)-led ward round; c) senior house officer-led ward round; d) consultant/SpR led board ward round; e) post-take ward rounds led by consultants; f) foundation year 1-led ward round (should not happen ideally).
Cardiology is predominantly a procedure driven specialty. Checklists will be very relevant in various cardiac patients who get admitted for various cardiac procedures ranging from ablation to percutaneous coronary intervention. This checklist could include vascular complications, follow-up planning details and also be individualised for each cardiovascular procedures. Checklists already exist for cardiac procedures in various NHS hospitals and they are embedded in procedural pathways. They become relevant in ward rounds as patients requiring overnight stay for their procedures will be reviewed by ward-based teams at some stage. For example, post-pacemaker implantation patients should have a chest X-ray the next day and a checklist-based system will facilitate the ward team to make sure this is reviewed before discharge. Overall, this reduces complications, clinical/nursing errors and facilitates early discharge of patients. It also provides one pathway communication between several teams involved in a patient's care.
Cardiology a ward rounds: rationale of using a checklist
It was rewarding to read Garg's vision for using checklists on a cardiology ward round. We would encourage medical specialties to practise using the ward round checklists and adapt them in accordance to their personal practice and specialty needs. Our experience has shown us that checklists are potentially useful in complex processes in which errors are common, or have serious effects, or both. It is important to make the purpose of the checklist obvious, stick to important points that tend to get missed, and keep the font large! The process of error checking should not slow the pace of work and should be embraced by every member of the ward round team.
Footnotes
Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk
- © 2011 Royal College of Physicians
Footnotes
Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk
- © 2011 Royal College of Physicians
