Care of the elderly medicine, North Bristol NHS Trust, Westbury on Trym, UK
BMJ Open Qual. 2023 Oct;12(4). doi: 10.1136/bmjoq-2023-002405.
NHS staff recruitment and retention have failed to keep pace with service demands and workforce burn-out is of significant concern. This quality improvement project (QIP) aimed to increase staff time for patient facing care through reducing duplication of hospital board rounds within a 36-bedded NHS inpatient geriatric ward.
Thirty-minute board rounds were reduced from twice daily (Monday-Friday) at 08:30 hours and midday to once daily at midday with the aim of freeing up staff time for patient care. A multidisciplinary team (MDT) safety briefing at 08:30 hours lasting 5-10 min was implemented to enable review of shift pressures and identification of patients who are unwell, newly admitted or due for discharge. Safety briefing format was amended to further support staff prioritisation.
This QIP was underpinned by the model for improvement, using Plan-Do-Study-Act cycles. Data were collected through a staff questionnaire alongside calculation of staff time spent at board rounds and safety huddles. Staff verbal feedback and questionnaire results were also used to improve and modify process'. Patient discharge data were collated via trust metrics as a balancing measure.
Through board round modification, 25 hours of MDT time was saved each week, with all responding staff reporting increased time for patient facing care following QIP implementation. >85% of questionnaire respondents agreed that board round changes resulted in improvement. Balancing measures collected as part of the project also revealed an increase in weekly ward discharges from an average of 15.75-17.5 confirming no negative impact on patient flow following board round amendments.
While significant staffing shortages continue, local innovations focused on staff time may have the potential to support effective use of limited resources.
英国国家医疗服务体系（NHS）的员工招聘和留用工作未能跟上服务需求的步伐，员工倦怠现象令人严重关切。本质量改进项目（QIP）旨在通过减少 NHS 36 张床位的内科老年病房中医院查房的重复，来增加面向患者的护理时间。
每天两次（周一至周五）的 30 分钟查房从 08:30 小时和中午减少到每天一次中午，目的是腾出员工时间进行患者护理。实施了一个多学科团队（MDT）的安全简报，时间为 08:30 小时，持续 5-10 分钟，以审查轮班压力和确定病情不佳、新入院或即将出院的患者。修改了安全简报格式，以进一步支持员工的优先事项。
本 QIP 以改进模型为基础，使用计划-执行-研究-行动（Plan-Do-Study-Act）循环。通过员工问卷调查和计算员工在查房和安全会议上花费的时间来收集数据。还使用员工口头反馈和问卷调查结果来改进和修改流程。通过信托指标收集患者出院数据作为平衡措施。
通过修改查房，每周节省了 25 小时的 MDT 时间，所有参与 QIP 实施的员工都报告说，在 QIP 实施后，有更多的时间用于面向患者的护理。超过 85%的问卷受访者同意，查房的变化导致了改进。作为项目的一部分收集的平衡措施还显示，每周病房出院人数从平均 15.75 人增加到 17.5 人，证实了在查房修改后对患者流量没有负面影响。
虽然持续存在严重的人员短缺问题，但关注员工时间的本地创新可能有潜力支持有限资源的有效利用。
