Identifying Quality Markers and Improvement Measures for Ward-based Surgical Care: A Semi-structured Interview Study

Introduction The surgical ward round (WR) represents the primary interface between the clinical team and the patient and is integral to the quality of postoperative care, and subsequent patient outcomes. Despite such a critical role, little scientific knowledge on this topic currently exists. This study aims to explore key issues pertaining to the surgical WR, defining challenges in current practice, and identifying potential means of quality assessment and improvement. Methods A qualitative, semi-structured interview-based approach was adopted. Interviewees represented varying stakeholders in general surgical ward rounds and included patients, nurses, interns, residents, and attendings. Subjects were interviewed using a pre-determined, semi-structured interview protocol. Interviews were recorded and transcribed verbatim, and subjected to emergent theme analysis by two independent coders. Results Twenty-five interview subjects were recruited across eight hospitals. 23/25(92%) believed that there was significant variation in the quality of WRs and that this affected patient care. A lack of thoroughness (18/25,72%) and poor communication (12/25,48%) were the most commonly identified causes. Non-technical skills such as communication (25/25,100%) were seen as crucial to WR quality. Quality markers for patient assessment and management were identified. Simulation-based training was the most commonly recommended (13/25,52%) intervention to improve WR performance. Conclusions Clinical staff and patients alike perceive there to be significant variability in current surgical WR practice, which places patients at risk and affects care. Further development of interventions, such as ward simulation, to assess and improve surgeons’ and surgical trainees’ performance is necessary to standardise and improve both WRs and patient care.