Identifying quality markers and improvement measures for ward-based surgical care: a semistructured interview study

• A semistructured interview study was conducted involving clinician, nursing, and patient stakeholders in the surgical ward round.
• Ninety-two percent of respondents believed that significant variations in quality placed patients at risk.
• Communication and lack of thoroughness were the most commonly cited causes.
• Quality markers to assess ward round quality were identified.
• Simulation-based training was the most common recommendation to improve practice.

BackgroundThe 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. 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.MethodsA qualitative, semistructured interview-based approach was adopted, including patients, nurses, interns, residents, and attendings.ResultsTwenty-five interview subjects were recruited across 8 hospitals. Twenty-three of the 25 (92%) subjects believed that there was significant variation in the quality of WRs and that this affected patient care. Lack of thoroughness (18/25, 72%) and poor communication (12/25, 48%) were the most commonly identified causes. Nontechnical skills such as communication (25/25, 100%) were seen as crucial to WR quality. Quality markers for surgical WRs were identified. Simulation-based training was recommended (13/25, 52%) to improve performance.ConclusionsClinical staff and patients alike perceive there to be significant variability in current surgical WR practice. Further development of interventions to assess and improve surgeons' performance is necessary to standardize and improve WRs and patient care.