Enhancing ward rounds for older patients with frailty: a modified Delphi process.

BACKGROUND

Despite their prevalence, ward round practices are not well described, leading to challenges in achieving proficiency. We aimed to identify consensus-based content items for conducting ward rounds with older patients with frailty to provide clearer guidelines and enhanced understanding of best practices for medical professionals.

METHODS

A nationwide Danish five-round Delphi study was conducted during 2023. Geriatric medicine (30) and medical communication (5) experts were invited to participate. The participants' comments and an iterative thematic approach were used to identify and refine content items and themes, after which participants assessed items for consensus. Consensus was defined as 75% of participants voting 7-9 on a 1-9 Likert scale. Items without consensus returned to the next Delphi round with elimination if no consensus was reached after the second assessment.

RESULTS

Delphi study response rates were 26(74%), 21(81%), 18(86%), 13(72%), and 11(85%) in Delphi rounds 1-5, respectively. Experts reached consensus on 108 content items on conducting ward rounds with older patients with frailty. Items were organised into four themes: (1) preparing ward rounds, (2) conducting ward rounds, (3) competencies, (4) circumstances related to the patient group. Ward round preparation and the conduction of ward round detailed the process of managing older inpatients with frailty, including conducting a holistic review of patient history and functional status, as well as improving the environment, such as by reducing noise. Competencies and patient circumstances related to the patient group included knowledge, skills, and attitudes to improve ward round quality, including flexibility in terms of reading patient cues and adjusting content to changes in cognition and alertness and knowledge on how to communicate with patients living with cognitive impairment.

CONCLUSIONS

Geriatric medicine and medical communication experts reached consensus on 108 content items for conducting ward rounds with older patients with frailty. The items were grouped into four themes: preparing for ward rounds, conducting ward rounds, required competencies, and patient-related circumstances. The authors believe that this study serves as a valuable resource for medical training and future research.