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Surgical Ward Round Quality and Impact on Variable Patient Outcomes

Pucher, Philip H. MD, MRCS*; Aggarwal, Rajesh MD, PhD, MA, FRCS*,†; Darzi, Ara MD, FRCS, FACS, KBE*

doi: 10.1097/SLA.0000000000000376

Objective: To investigate the relationship between variability in surgical ward round (WR) quality and clinical outcomes.

Background: Evidence increasingly suggests that ward-based care plays a key role in surgical outcomes. The WR is the focal point of surgical inpatient care. Assimilating various sources of clinical information is necessary for thorough patient assessment during the WR; whether this relates to outcomes has not previously been examined.

Methods: WRs were observed for patients on a surgical high-dependency unit in a tertiary academic surgical unit. All sources of clinical information (SCI) were considered. Thoroughness of assessment, defined as the percentage of SCI assessed by the clinician, was recorded as a marker of WR quality. Complications were recorded from patient records; preventability was based on Agency for Healthcare and Research Quality guidelines. The relationship between WR quality and incidence of preventable complications was analyzed.

Results: Sixty-nine WRs were observed over 37 days for 50 patients receiving care in the high-dependency unit. Observed morbidity rate was 60% (30/50). Seventy-four percent of all complications (35/46) occurred on the high-dependency unit. There was significant variability in WR quality: clinicians assessed 9% to 91% (mean = 55% ± 17%) of SCI (analysis of variance P = 0.025). Low-quality (% SCI assessed less than the mean) WRs resulted in a greater incidence of patients experiencing preventable complications [83% (10/12) vs 39% (7/18)] (P = 0.034), odds ratio = 6.43 (95% confidence interval = 1.05–39.3). Forty-one percent of complications (19/46) could have been diagnosed earlier or possibly prevented.

Conclusions: Patient assessment during WRs is variable. Less thorough WRs result in delayed diagnoses and preventable complications, and they negatively affect outcomes. Focusing on WR quality and training may improve patient care.

Evidence increasingly suggests that ward-based care, of which ward rounds (WRs) are a focal point, plays a key role in surgical outcomes. WRs for 50 patients were observed on a surgical high-dependency unit. Significant variability in WR quality was observed, with low-quality WRs resulting in greater incidence of preventable complications. Focusing on WR quality and training interventions may improve patient care.

*Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, United Kingdom; and

Department of Surgery, University of Pennsylvania, Philadelphia.

Reprints: Philip H. Pucher, BSc, MRCS, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, 10th Floor QEQM Bldg, Praed St, London W2 1NY, United Kingdom. E-mail:

Disclosure: No funding was received for this body of work, and the authors declare no conflicts of interest. Rajesh Aggarwal is funded by a Clinician Scientist Award from the National Institute for Health Research, United Kingdom.

© 2014 by Lippincott Williams & Wilkins.