Restore ward rounds to former glory to improve patient care, say colleges

Doctors’ and nurses’ leaders have called for ward rounds to be restored to the position they once held as the cornerstone of hospital care and for a “concerted culture change” to enable clinicians and mangers to work together to improve quality.

In a joint statement the Royal College of Physicians and the Royal College of Nursing said that ward rounds were often neglected during the planning and organisation of patient care.1 How and why hospitals conducted ward rounds was variable, and their value to patients and the whole clinical team was often underestimated, the statement said.

Currently, doctors often conducted ward rounds on their own and made clinical decisions while nurses were delivering care.

However, ward rounds served several functions. They helped establish and refine the diagnosis; reviewed progress, treatments, and investigations; formulated discharge arrangements; communicated with the clinical team and relatives; ensured safety; and provided training.

Reinstating ward rounds that included the whole of the clinical team would help deliver compassionate care in which doctors and nurses worked more closely together, said the statement.

It added, “Ward rounds are critical to developing rapport and building trust with patients, while discharging a duty of care. Ward rounds also enable all individuals involved to express a shared aspiration to make the patient the centre of attention, empowered in his or her own care.”

The statement included seven recommendations to make ward rounds more effective in delivering the right care and also in building rapport and trust with patients.

These say that ward rounds should be led by consultants, include a nurse, and be conducted in the morning to allow time for tasks set to be completed the same day. Everyone involved should be briefed before the round. Patients, their carers, and relatives should be given a summary sheet outlining what was discussed, while people with dementia or learning difficulties should be supported in making decisions about their care.

To promote effective communication and team working, patients’ records should be kept centrally, said the statement. And ward round teams should use locally adapted checklists to reduce omissions, improve patient safety, and strengthen multidisciplinary communication.

The foreword to the statement said: “Despite the complexity of the processes involved, the significance of opportunities presented on ward rounds is often underestimated. Doctors and nurses need to understand the wider impact of their approaches to ward care, whilst managers and the executive board bear a responsibility to protect time and resources, enabling all members of the multiprofessional team to prioritise the ward round.”