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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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!!!

8. 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

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

11. 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

12. “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