Plastic surgery ward round: can we do better?

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Excerpt

The ward round is a time‐honoured tradition of surgical practice, affording the treating surgeon an invaluable opportunity to assess a patient's current state and temporal progress, formulate crucial management plans and liaise with both the patient and ward staff. Commonly, this is undertaken early in the morning, allowing for this process prior to a morning session of either operating or consulting. In the public hospital setting, the ward rounds allow for more widespread communication as well as the opportunity for both teaching and learning.1
With the ever‐increasing demands on staff in the public hospital system, this process is often truncated. The potential for increased use of medical jargon, discussion solely amongst medical staff, breach of privacy and inadequate patient interaction and comprehension arises in this setting. Patients may feel excluded from their management, and therein exists the potential for a paternalistic model of care. While there are numerous anecdotal accounts of this occurring, little has been described in the literature, and less in Australian hospitals. Furthermore, in current reports there is minimal quantitative data presented,2 thus failing to educate the treating surgical team about the experiences their patients undergo.
With ethics approval, we administered a survey to adult patients admitted under the Plastic, Reconstructive and Hand Surgery Unit bedcard. The patients were often reviewed in a multibed room with curtains drawn for privacy. The surgical team comprised at least seven members: two registrars, two residents, a bedside nurse and nurse unit manager and a pharmacist. The surgical team were unaware of the surveys being conducted, to ensure no bias in their conduction of the ward round. After consent from the participants, surveys were administered between 09.00 and 11.00 hours. Surveys were administered irrespective of their perioperative status, or whether they had previously contributed to the study.
Over an 8‐week period in late 2015, 81 patient surveys were conducted, with 29 (35.8%) of these being completed by patients who had previously taken the survey.
By 11.00 hours, 73 (91.1%) patients reported having been visited by the ward round; the other eight patients were thus unable to complete the remaining items and were excluded from further analysis.
Whilst most patients understood the purpose of the ward round (70 (95.9%)), the majority of participants (55 (67.9%)) were unaware of when the ward round was scheduled to take place. A higher proportion (65 (89.0%)) felt that adequate time was spent with each patient. Reassuringly, 70 patients (95.9%) felt that their privacy and dignity was respected.
The language of the ward round was largely considered understandable by 69 (94.5%) patients. The same proportion felt able to ask questions and raise concerns until all issues had been resolved (69 (94.5%)). Only 42 (57.5%) felt that they were able to contribute to decisions being made. Overall, 61 (83.6%) felt that they understood the medical plan for the day, and 68 (93.2%) felt that the plan was shared with all staff. Only 35 patients (47.9%) agreed that they were aware of their likely discharge date.
There were 21 patients who took the survey once, and 26 who undertook the survey multiple times. Surveys were administered to patients who had already participated in the study to assess whether increased stay translated into improved interaction and understanding of anticipated discharge date.
In patients who had undertaken multiple questionnaires, the results were similar to those undertaking the questionnaire only once. There was a slight increase in patients feeling that their privacy and dignity was respected (26 (100%)), and in understanding of the language used on the ward round (25 (96.2%)). More patients (17 (65.
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