Practicum Summary Report
Name: Mohamed Elseedawy
Team Members: Jane Simpson and Szeyi Lai
Project Title: Improving the management and satisfaction of medical and surgical boarded patients in the Ear, Nose and Throat (ENT) ward in Ninewells Hospital.
University/Organization Name: Dundee University
Health System Sponsor Name: Mr Rodney Mountain
Aim of project (1-2 sentences)
Our aim is to improve the percentage of boarded patients in the ENT ward being reviewed daily. Specifically, we have set a target of 95% or greater by the end of the four weeks allocated to carry out this project (11.04.16-06.05.16). We also aim to improved the satisfaction scores of patients boarded in the ENT ward to over 95% by the end of this same four-week period.
Planned changes tested (2-3 sentences)
Firstly, we will speak to various members of the healthcare team and collect baseline data by reviewing the patients' notes on a daily basis to see if they are being reviewed appropriately each day. After obtaining baseline data we will document the percentage of boarded patients being reviewed after we implement a reminder tool on the ward by placing stickers in the patients notes and by speaking to the medical and nursing staff from the parent ward regarding the care and management of boarded patients. We will also look into the use of the electronic whiteboard on the ward amongst staff and collect data from staff in regards to how useful they find the whiteboard and whether any improvements can be made. We will also introduce a tool to ensure that the white board is updated regularly and hope to show that this in turn will improve the frequency of boarded patient reviews.
We will also speak to patients in the ward and learn about their patient journeys through the hospital from admission through to other wards and then finally finishing with them being boarded in the ENT Ward. After speaking with these patients we will then write a Patient Experience and Satisfaction Survey and ask boarded patients in the ENT Ward to complete this for us. We then plan on handing out a patient information card to all boarded patients on arrival to the ward and then re-test patient satisfaction and experience through another survey. We will then be able to compare results and be able to measure the effect of handing out a patient information card to boarded patients.
Predictions (2-3 sentences)
As a result of our study, we hope to increase overall patient satisfaction to over 95% after handing out patient information cards to every boarded patient on the ward.We predict that patient satisfaction regarding the amount of information they are provided with on arrival to the ENT Ward will also increase to 95%. However, we do not think that we will be able to improve initial patient satisfaction when told that they will be moved from their parent ward to the ENT ward as we are not able to implement any test of change at this level during our short time carrying out this project.
We predict that our baseline data will show that a large proportion of boarded patients on the ENT ward are not reviewed on a daily basis, thus leading to longer length of hospital stays and increased workload for staff. We also predict that staff may feel that they are not confident when having to care for boarded patients. We believe that our proposed interventions will improve the number of patients being reviewed on a daily basis.
In regards to the whiteboard on the ward, we predict that the electronic whiteboard on the ward is already being utilised well by staff.
Results
Present your results with a graph(s).
Run Chart 1) Frequency of Reviews of Boarded Patients in the ENT Ward:
Bar Chart 1) Staff Survey results regarding electronic whiteboard
Bar Chart 2) Staff Survey results regarding use of electronic whiteboard
Run Chart 2) Improving Patient Experience and Satisfaction of boarded patients in the ENT Ward
Summary of results (3-4 sentences):
The baseline data we collected regarding the percentage of boarded patients who are being reviewed daily was consistentlyfound to be 100%. This was different to our prediction. After speaking with staff we feel that our results are due to seasonal variation in boarder numbers and having fewer boarded patients in the ward than expected. Due to this baseline data, we decided that it was not appropriate to carry out our proposed interventions as we would not be able to improve the percentage of patients being reviewed daily. In regards to the data we collected on the use of the electronic whiteboard it was clear that staff members did not think it was beneficial. We also found that the whiteboard was not being regularly updated and no one was given this responsibility and therefore the board was not always accurate and sometimes the location of boarders was not clear. Ultimately we think that having a named person responsible for updating the board would be most effective in achieving this.
After speaking with one boarded patient about their experienceas a boarded patient on the ENT ward, we then composed a Patient Experience and Satisfaction Survey. This revealed that although someof the 6 patients were satisfied with the overall care they received during this hospital admission, it also revealed areas for improvement including poor satisfaction when initially being told they would have to move wards and inconsistencies between the amounts of information patients were given both prior to moving wards and after arriving in the ENT ward. To help improve the consistency in the amount of information patients are given once arriving in the ENT Ward, we workedalongside the nurses and doctors in the ward and created a patient information card to be given to all boarded patients after they arrive on the ward. We started by trialing this with one boarded patient on the ward to test to see if this improved their satisfaction regarding the amount of information given on arrival to the ENT ward. This was in fact the case so we then gave the patient information cards to other boarded patients on the ward. Due to the fact that there weren’t a large number of boarders, we only managed to test this change with 3 patients. The results from these patients were promising and showed that 97% of boarded patients were satisfied with the amount of information provided on arrival to the ENT ward after we implemented this test of change. It also showed that 97% of patients were satisfied with their overall experience during this hospital admission.
Learning (4-5 sentences)
Comparison of questions, predictions, and analysis of data:
In our first PDSA cycle we looked into the number of boarded patients reviewed on a daily basis. We wanted to see weather the frequency of boarded patient reviews improved by placing stickers in the patients notes, by speaking to the medical and nursing staff from the parent ward regarding the care and management of boarded patients, and to ensure that the whiteboard was also updated regularly.
We predicted that data collected would show a large proportion of boarded patients on the ENT ward not being reviewed on a daily basis.
The data collected over 10 days by our team (Jane, Szeyi and Mohamed) showed that a 100% of boarded patients on the ENT ward were reviewed daily. This data was different to the data that we had predicted.
In our second PDSA cycle, we explored the experience and satisfaction of boarded patients on the ENT ward. We tested whether providing a patient information card to all boarded patients would improve overall patient satisfaction and experience.
We predicted that patient satisfaction regarding the amount of information given to them on arrival to the ENT ward would increase to 95% after handing out patient information cards to every boarded patient on the ward.
The data collected by our team (Jane, Szeyi and Mohamed) showed that on average patient satisfaction in this area was greater than 95%. However it must be noted that we only collected data on 3 patients due to the lack of boarded patients on the ENT ward during this project.
Impact on systems (3-4 sentences)
Discuss the project’s significance on the local system and any findings that may be generalizable to other systems:
The overall management and care of boarded patients and their safety will be improved if they are reviewed regularly. Patient information cards being handed out to all boarded patients will ensure consistency regarding the information patients receive when they arrive in the ENT ward, and also enhance overall patient experience and satisfaction.
The nurses on the ward will be responsible for handing out these patient information cards. Members of staff should gain from this as they will be ensuring that all patients are receiving the same amount of information and this improving consistency of care.
Conclusions (3-5 sentences)
Summarize the outcome of the project. Is this project sustainable? What are the requirements for sustainability?
Our baseline data showed that 100% of boarded patients were being reviewed daily which meant that at this present time, there was no opportunity for us to test any interventions. We believe these results to are not a true reflection of the boarding review situation due to the small boarded patients in the ward at this time of year.
In regards to patient experience and satisfaction it was clear that there are many contributing factors. Regarding the area of information given to patients on arrival to the ENT ward, we saw an improvement in patient satisfaction after initiating our pre-written patient information cards. We believe that once we are able to get the ward staff on board with this initiative and ensure they are giving out these information card to all boarders, this should be sustainable, however it does rely on staff agreeing to this commitment.
Reflections/Discussions (5-7 sentences)
Discuss the factors that promoted the success of the project and that were barriers to success. What did you learn from doing this project? What are your reflections on the role of the team?
The main factor that promoted the success of this project was having supervisors that were continually supportive and were able to offer lots of good advice. A multidisciplinary approach is needed to ensure that patients receive the best possible management and care.
The main barrier to the success of this project was the small number of boarded patients on the ward during our time carrying out this project. We put this down to seasonal variation, as we know that at other times of the year a greater number of boarded patients are cared for in the ENT ward, Ninewells Hospital. We don’t believe our data truly reflects the situation, as staff members we spoke to said they feel there is a problem when the ward has more boarders. Despite facing this main barrier, we were still able to explore further improvement measures, which could be trialed during busier periods.
This project highlighted to us how challenging it can be to carry out an improvement measure as we realised that the process relies on many uncontrollable factors. As ateam we learnt about the importance of communicating effectively and keeping everybody up-to-date with how our project was getting on.
On reflection, this was a great experience and we feel this has opened our eyes into the world of health care improvement and has given us the motivation to continue doing this type of work in the future.
By signing this document (electronic signature is acceptable), I attest that the information provided by the learners in this project is accurate.
LEARNER(S):
Signature: Mohamed Elseedawy
Printed Name:Mohamed Elseedawy
Area of Study:University of Dundee - Medicine
Signature: Jane Simpson
Printed Name:Jane Simpson
Area of Study:UoD - Medicine
Signature: Szeyi Lai
Printed Name:Szeyi Lai
Area of Study:UoD - Medicine
FACULTY SPONSOR:
Signature: Peter Davey
Printed Name:Peter Davey
Institution:University of Dundee
HEALTH SYSTEM SPONSOR(if different from faculty sponsor):
Signature: Mr Rodney Mountain
Printed Name:Mr Rodney Mountain
Institution:NHS Tayside
AUTHORIZATION
Do the learners, faculty sponsor, and health system sponsor authorize this projectfor publication at
☐ Yes☐ No