Treloar Ellie C, Ey Jesse D, Herath Matheesha, Edwardes Nicholas P R, Edwards Suzanne, Bruening Martin H, Maddern Guy J
Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.
Br J Surg. 2025 Mar 28;112(4). doi: 10.1093/bjs/znaf041.
Poor quality ward rounds contribute to a large proportion of patient complications, delayed discharge, and increased hospital cost. This systematic review investigated all interventions aiming to improve patient and process-based outcomes in ward rounds.
This systematic review was prospectively registered in PROSPERO, the international prospective register of systematic reviews (CRD42023394325). MEDLINE, Embase, Emcare, and PsycInfo were searched for studies with interventions aiming to improve ward round processes or patient outcomes in hospital settings. Studies were excluded if there was no baseline comparator or they were not in the ward round setting. Interventions were coded as checklist interventions (that is electronic or paper-based pro formas, templates, and checklists), structure interventions (that is defined rules or protocol to guide or standardize conduct), or other interventions. Outcomes were assessed via meta-analyses using the I2 statistic, Cochran's Q P value, and random-effects models. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the Newcastle-Ottawa scale for non-randomized studies.
This review included 84 studies, from 18 countries, in 23 specialties, involving 43 570 patients. Checklist interventions significantly reduced ICU length of stay, improved overall documentation, and did not increase ward round duration. Structure interventions did not increase the time spent per patient or impact 30-day readmission rates or patient length of stay.
This is the first systematic review with meta-analyses synthesizing the evidence of all ward round interventions targeted at improving patient and process outcomes. Results from this review should be used to inform guidelines for the 'ideal ward round'.
质量不佳的查房导致很大一部分患者出现并发症、延迟出院和医院成本增加。本系统评价调查了所有旨在改善查房中患者及基于流程的结局的干预措施。
本系统评价在国际系统评价前瞻性注册库PROSPERO（注册号CRD42023394325）中进行了前瞻性注册。检索了MEDLINE、Embase、Emcare和PsycInfo数据库，以查找旨在改善医院环境中查房流程或患者结局的干预措施的研究。如果没有基线对照或研究不在查房环境中，则将其排除。干预措施被编码为清单干预措施（即电子或纸质形式的预印表格、模板和清单）、结构干预措施（即指导或规范行为的既定规则或协议）或其他干预措施。通过使用I²统计量、Cochrane Q P值和随机效应模型的荟萃分析来评估结局。使用Cochrane偏倚风险2工具评估随机对照试验的偏倚风险，使用纽卡斯尔-渥太华量表评估非随机研究的偏倚风险。
本评价纳入了来自18个国家、23个专业的84项研究，涉及43570名患者。清单干预措施显著缩短了重症监护病房（ICU）住院时间，改善了整体记录，且未增加查房持续时间。结构干预措施未增加每位患者的查房时间，也未影响30天再入院率或患者住院时间。
这是第一项进行荟萃分析的系统评价，综合了所有旨在改善患者及流程结局的查房干预措施的证据。本评价的结果应用于为“理想查房”指南提供信息。
