The value of the post-take ward round
Editor – The Royal Liverpool and Broadgreen Hospitals NHS Foundation Trust was one of the European Working Time Directive pilots for Skills for Health funded by the Department of Health. Their work has highlighted the benefits of clinical leadership and innovation with the creation of an acute response team for 24-hour emergency care. The learning from this has been widely shared www.healthcareworkforce.nhs.uk/liverpoolbroad-greenpilot/
In this study a number of parameters improved between 2006 and 2008 including the presence of the attending team on the post-take ward round (PTWR) (2.9% to 8%, p=0.003), diagnosis recorded in notes (82.7% to 88.9%, p=0.02) and the number of patients not receiving senior review fell from 3.2% to 0 (p<0.001).
The paper by Chaponda and colleagues highlights the benefits of increased consultant presence in quality of patient care and also emphasises the need for the restructuring of consultant working practices in order to deliver junior doctor training during the out-of-hours period ie outside of the traditional nine to five working day (Clin Med August 2009 pp 323–6).
The authors accept that by moving the PTWR to an earlier slot the night team would be able to attend. In order to make this a reality, it requires innovative revision of consultant job plans so that they are both re-numerated adequately for their time and released from other duties during acute on call.
There is no mention of the benefits of structured consultant-led handover as a valuable learning experience during which results can be reviewed and diagnoses questioned. In addition the significant improvements in information technology that have occurred over the last few years mean that patient's results are available anytime day or night.
Junior doctors also have a responsibility themselves to ensure that they follow-up cases that they have admitted and use any changes in diagnosis as ideal topics for case-based discussions.
In conclusion we must ensure that the benefits to patients of new ways in working also extend to delivering quality training for our juniors and this may require a paradigm shift in consultant working practices.
Footnotes
Please submit letters for the Editor's consideration within three weeks of receipt of the Journal. Letters should ideally be limited to 350 words, and sent by email to: Clinicalmedicine{at}rcplondon.ac.uk
- © 2009 Royal College of Physicians
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