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Report of Findings from Visit to Worthing Hospital to see Dr Gordon Caldwell’s Post Take Ward Round Process Delivering Safer Care Friday May 14th 2010

Doctor Gordon Caldwell has been studying the reliability of clinical and administrative processes that enable timely, effective, safe and productive treatment of patients admitted to medical beds at Worthing Hospital and how these processes support (or not) the optimum outcome of care for patients.

The post take round commences with a collective discussion in the Post Graduate Centre aided by technology that enables a view of the patients on a ‘virtual ward’ and open discussion on their condition and care to date. Dr Caldwell reminds his team of junior doctors with a visual reminder of their core purpose of – Right DiagnosisRight TreatmentNo Avoidable Harm and Door to Doctor Time 30 minutes for new admissions.

Dr Caldwell has been researching ‘high reliability organisations’ such as the airline industry and reading internationally renowned authors on the subject of reliability and safety to support the development of processes that can transfer to the NHS so building safety into the system and by association increase the quality of care and reduce unnecessary cost.

Key elements of Dr Caldwell’s work to improve safety and effectiveness on ward rounds has been to introduce:

  1. A cockpit style discussion area to enable himself and his team have uninterrupted discussions about each patient under their care. This discussion area enables them to discuss each patient without interruption and whilst viewing the ‘vital signs’ information.
  2. A ‘ward round checklist’ that ensures all areas are covered for all patients each and that without the checklist something vital may be missed.
  3. A ward round trolley – purposefully designed to support the ward round process; enabling all information to be at the teams hands and saving time in running back and forth to the nurse station area.

This approach toward rounds also means that junior doctors are able to lead discussion with patients, supported by other team members and the Consultant. Enabling confidence building in leading the ward round process and assuring that all team members have an input and are vigilant and work together to cover all aspects of care.

Other elements of Dr Caldwell’s approach to assuring ‘safer care’ have been the introduction of checklist bookmarks for patient notes. These bookmarks remind the clinical team to check vital areas/ ask themselves key questions in delivering patient care especially in completion of the medical record; medication recording; interaction with the patient – an essential part of assuring safety and quality of care.

Dr Caldwell has introduced a ‘Patient Safety Checklist’ for Trust Directors to use on ward visits that enable them to see safety issues from the view of a clinician on the ward. This helps to develop shared corporate understanding of safety issues and how to create a Trust wide approach to quality; safety and delivering better value for money through improved care processes.

Dr Caldwell is currently working on developing patient information to support their conversations about their care – questions they and/or their families have, increasing involvement dialogue, reassurance and understanding about their care.

This is pioneering work in the application of safe design in hospital medicine and needs advocating and promoting widely. I hope Dr Caldwell is supported in applying for a Health and Social Care award.

Published 1st November 2018