Omitting repetitive clerking does not disadvantage cardiology patients and reduces duplication

Abstract

Nottingham University Hospital's cardiology department receives an average of 320 admissions via the emergency department (ED) monthly. The majority are out-of-hours. In ED, admissions are clerked by ED doctors as well as the specialist cardiology advanced nursing team (CATS). Upon transfer to cardiology, they are then re-clerked by an on-call junior doctor (JD). Our aim in this quality improvement project was to investigate the benefit of re-clerking cardiology patients by the JD. The CATS team clerking and plan were directly compared to the JD's plan across 100 patients by two reviewers. Data were also collected on the time spent performing a clerking by nine JDs. An alternative form of reviewing patients, which involved the JD reviewing the CATS clerking, bloods, observations and discussing with nursing staff, was performed in 29 cases. In 5% of cases a JD changed the management plan. Three cases were flagged to doctors by nursing staff, and two cases involved starting oral antibiotics. The average time spent clerking patients previously was 49.5 +/212 minutes (mean+/2SD). In the new method, this was 12.5 +/23 minutes. We conclude that 0mitting repetitive clerking does not disadvantage patients, while saving time for on-call JDs. Patients are also not woken up unnecessarily overnight, which may reduce the risk of delirium. We plan to rationalise our admission system.