The 'Board Round' – streamlining the morning MDT meeting Adam Williamson, FY1 Frances Buckley, CMT1 Josh Coats FY1

What is the setup? Morning 'board round' for discharge planning Facilitated by nurse in charge Pre-existing protocol - aim to discuss: Estimated date of discharge PT/OT Social Work ?any change to PDD ?referrals to make

What was the issue? Often the discussion was lengthy or became very focused on one aspect of the patient's issues Discharge planning – not always setting a date Differing opinions on what the round was meant to achieve

Aims Not set in stone! Assess and improve team satisfaction Protocol compliance To improve timing parameters of patient discussion to allow staff to spend more of their day caring for patients

Data Collection Small daily samples of patients monitored: Was it discussed (PT/OT/Medical/Nursing/SW/PDD) Later added ‘was it relevant to this patient?’ Logged time spent discussing each aspect of team input Preliminary data: 53 seconds per patient 31% of time spent on patient introduction 37% related to medical staff

Data Collection Team unfamiliar with the existing protocol Likert Scale – ‘usefulness in planning your day’ 7.75/10 Role Average score/10 Physio 7.5 OT 7 Nursing Medical 8

PDSA Cycles….and a lot of scratching of heads 1st cycle – posters next to ward board INCREASED total mean discussion time to 71 secs (53) INCREASED proportion discussing medicine to 72% Improvement isn’t easy!!!

Eureka! 2nd cycle: Change of facilitator from nurse in charge to ward physiotherapist Reduced total to mean 30 seconds per patient 75% of discussion is still related to medical staff

Further Development Education of team regarding aims of meeting ?change protocol Change time of meeting Revisit why team members didn’t score 10/10

Next steps I am working on BMJ Quality modules – should lead to publication in BMJ-QIR Scope to do IHI modules + get qualification PT continues to facilitate the board round

“how can I make my QI project a success” don’t think ‘if it ain’t broke, don’t fix it’ there is always scope to improve don’t be disheartened! not about ‘one quick fix’ inertia can be overcome! work in a team: a) you can’t be there all the time b) you’re trying to think of improvements – synergistic brainpower c) ideally multidisciplinary – get everyone on board