7 Day Consultant Ward rounds for medical emergency admissions
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Transcript of 7 Day Consultant Ward rounds for medical emergency admissions
7 Day Consultant Ward rounds for medical emergency admissions Seven day services in action
16th November, Hilton Metropole
Mark TempleConsultant Physician & Nephrologist
Heart of England Foundation TrustAcute care fellow, RCP
Concern quality & safety patient care (OOH): RCP Position statement November 2010
Hospitals undertaking the admission of acutely ill medical patients should have a consultant physician on site for at least 12 hours per day, seven days a week, at times relating to peak admission periods. The consultant should have no other duties scheduled during this period.
Delivering high quality care beyond AMU 7 day consultant review Medical & surgical wards
Particular risk: Transfer out of AMU within 24-48 hrs – evolving acute illness
Move to a different landscape!From AMU : enhanced staffing (cons) organisation of careTo wards:
– Unfamiliar with pt/acute care– Uncertainties about diagnosis & management – Quality monitoring /response pt deterioration?
Patient transfer Friday pm (next cons round 72 hours +?)
Pts transferred out of AMU – receive a consultant review within 24 hrs – 7/7
Patients transferred out AMU: Early review - Consultant of team responsible for continuing care – “Golden Hour” priority duty in first working hour– Template cons physician working 7/7 all wards
• “Buddy” arrangements : link medical teams to Surgical wards
• Weekday: re-schedule conflicting duties 8.30-10• Weekend: consultant rota for shared bed patch• Review all new transfers in + acutely ill
Aim: Consistent consultant review, critical time acute illness
• Confirm diagnosis, Rx, discharge, ceilings of care
• Involve/ communicate management plan to new ward team
• Senior assessment vs anticipated clin. trajectory
• Support ward team & covering med staff – concerns unfamiliar patient
• Benefits of consultant delivered care
Acad Royal Med Coll 2012
• NCEPOD consistent evidence delayed/ absent consultant care = unsafe poor quality care
• AKI: Adding insult to injury 2009
• Time to intervene 2012
Birmingham Heartlands Hospital – Consultant Physician duties 7 / 7
Review of unselected (GIM) patients WeekdaysMedical & Surgical wards
0845 – 6 consultants with ongoing care duties:
Initial: “smart start” board round
Clinical review • all new transfers in• sick pts / potential discharge
Week-ends & BHsMedical & Surgical wards
0900 – 4 consultants (ongoing care) Initial: Handover
Clinical review • All new transfers in • Sick pts / discharge
Achieving consultant “Golden hour” rounds - all wards with unselected (G)IM in-pts
• Widespread recognition – good for patient care– Consultant agreed and
implemented• More acute physicians –
allowed redeployment • Reassured : reliable JD support
– Assist with admin, discharge, request tests, prescribing
– Optimal use consultant time OOH
– Optimal use consultant expertise – senior decision making
• Reassured : staff & support 7/7 to implement consultant plan – Therapy , diagnostic and social
services. Pathways out of hospital
• Recognise extra work- job plan (4 extra physicians on site)
• Use existing synergies. Greatest resistance to additional w/e rota - consultants not providing 24/7 service
How to change consultant working The Physicians story - Paul Woodmansey (2011)
• AMU consultant cover 12hrs w/d, 6-8hrs w/e
• W/E Troubleshooting Consultant visits all med wards : sick & quick d/c
• Increase early discharge• Coincided reduction
mortality (all and w/e)
• Major change working life : introduced with relative ease
• Consultant proposed tried & accepted
• Good for pt care• “Greatest challenge is cons
delivered (not led) service required”
• “Pace .. in hospital .. pts need daily senior input” Clin Med 2011 (11) 1: 17-19
Impact of “Golden hour” ward rounds
• Nursing staff: welcomed cons on their ward 7/7. Decisions on existing in- patients.
• Jun Doctors: – reduced workload – Improve training, feedback
• Consultants / ALL :Monday working more manageable
• Where d/c pathways not @ w/e discharge set up for Mon/Tues
• Associated : improved LOS