Who is your consultant?

1. Introduction

Recommendation 236 from the Francis Inquiry Report 2013 states that hospitals should reintroduce the practice of identifying the clinician that is responsible for a patient’s overall care A named nurse should also be nominated at each nursing shift for each patient 1 This principle requires clinicians to be accountable and ensure effective communication with patients and their supporters.

2. Aims and objectives

• The primary aim is to ensure that a patient’s stay in hospital is ‘coordinated, caring, effective and efficient’ with the responsible clinician taking responsibility for the patient’s overall care2

• Every patient should know who their named consultant is.

• Every patient should know the name of the nurse responsible for their care

• Relevant information should be clearly displayed eg: above the patient’s bed (2)

• All of the above is to ensure effective and accurate communication between the patient and their clinical team

3. Drivers

4. Methods

Baseline data collection

Baseline data was collected through the use of a questionnaire:

• Who is your consultant?

• How would you find out?

• Who performed your operation?

• Who is your nurse?

• Are you aware of your long term plan?

Other data was collected from the patient notes:

• Headboard information – correct or incorrect?

• Length of hospital stay

• Patient surgical status

Patients with dementia or cognitive impairment were excluded In total 43 patients were surveyed

Baseline data was used to propose and implement change – every patient should know who their Responsible clinician and named nurse are.

Implementation of change

PDSA (Plan, Do Study, Act) cycles were formed

PDSA 1: Education of junior doctors to ensure that headboard information is correct

Education of Junior doctors on the ward took place This was to ensure that patients are told who their named consultant is This also included ensuring the patients understood who is responsible for their overall care Junior doctors were provided with marker pens They were given the responsibility of ensuring headboard information was correct

The wards were re-audited using the same questionnaire, with the addition of the following question: “how satisfied are you with your care from 0 to 10. (0 is the worst and 10 is the best).”

5. Results

• Baseline data indicated that less than half of the patients knew who their named consultant was

• After implementation of PSDA 1, more than half of the patients knew who their named consultant was.

• The results are graphically summarised below

• Results have been further stratified to highlight the differences found between elective patients and emergency patients

Post-implementation data was further analysed

There appears to be a strong correlation between correct headboard information and patients’ awareness of their consultant

6. Discussion

Baseline data indicated that the hospital was significantly underperforming in line with the recommendations made in the Francis Inquiry Report There were significant improvements in performance after the implementation of PDSA1.

However, the standard set by the guidance is that every patient should know who their responsible clinician and named nurse is PDSA 1 did not lead to improvements that were fulfilling this standard – there were a significant proportion of patients unable to name their consultant

Without identification of a team leader ‘confusion can creep in’ for patients, ultimately impacting their inpatient experience Therefore, steps must be taken to improve the hospital’s performance

Limitations and challenges

• Small sample size – a larger sample size would increase the power of the audit and be more representative of the actual patient cohort

• Did not include medical/obstetric/paediatric patients.

• PDSA 1 utilised a bottom-up approach – the medical student carrying out the audit was responsible for educating and motivating the junior doctors on the ward Motivation and engagement with making changes was low amongst junior doctors

• High patient turnover and the fast-paced environment in the surgical assessment unit made implementation of PDSA 1 challenging – is there a different approach that is more suitable to this environment?

• “There are a lot of nurses” – many patients reported recognising nursing staff’s faces but not their names, often due to shift changes

• Often the headboard is blank – encouraging nurses to implement changes in the current bureaucracy is challenging

7. Future

• PDSA cycle 2: We will utilise a top-down approach – the consultant surgeons will be informed about the current findings of the audit during a departmental meeting They will be given responsibility to ensure junior doctors are motivated to drive the change

• PDSA cycle 3: Patients will receive an admission card, stating their responsible clinician and named nurse This is in accordance with the guidance, that states ‘relevant information should be appropriately displayed.’

• A re-audit will subsequently take place

• Future audits will include a range of specialties