Team Ward Rounds for Quality Improvement in Patient-Centred Care: An 'Acute Care for Elders' Unit Experience

Abstract

Patient-centred care is a core value in Geriatrics and requires effective  communication between patients and multi disciplinary professionals. Accurate and timely implementations of care plans are also important to achieve desired  outcomes. The Acute Care for Elders (ACE) Unit in University of Benin Teaching  Hospital (UBTH), Nigeria admits older adults with multiple medical morbidities under the care of consultant physicians on call, and a geriatrician who oversees unit activities. Patients and their relatives require support to effectively communicate their healthcare needs to multiple managing teams. Care coordination was also
required. In this paper we describe a clinical practice change for evaluation and continuous quality improvement of in-patient services in our ACE unit, such as daily geriatrics (multi disciplinary) team ward rounds preceding traditional ward rounds by other managing teams. The geriatrics team rounds enabled the identification of lapses in implementation of patient care plans, amongst which documentation and
medication errors were the leading. Our interventions included communication with patients, between members of the multi disciplinary geriatrics team, and with doctors in other managing teams. We conclude that daily multidisciplinary team rounds are feasible in Nigeria and useful for service evaluation and quality improvement in patient care. The rounds enabled the identification of the most pressing targets for quality improvement in patient-centred care: improved documentation and reduction in medication errors.

Key words: Ward rounds, Quality improvement, Patient centred care,   Multidisciplinary teams, Geriatrics, Nigeria