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The Urology Checklist towards a Structured Consultant-Led Ward Round

Jennie Han, Josh Gibbard, Colin Cutting and Elsawi Osman*

Objective: Formulating a comprehensive, practical, and urology-focused ward round checklist to enhance safety, efficiency and clear documentation for the Urology ward team when reviewing in-patients.

Design: Identification of important parameters which should be addressed in every patient interaction. FIASCO – VH was coined for ease:

• Fluid balance

• Investigations

• Intravenous access

• Antibiotics

• Analgesia

• Stool

• Catheter status

• Observations

• Venous thromboembolism (VTE) risk assessment

• Home and follow up.

Baseline measurement followed by implementation of the checklist and completion of three plan-do-study-act (PDSA) cycles.

Setting: Single-centre district general hospital within the United Kingdom

Participants: 279 ward round interactions with Urology inpatients

Intervention: Implementation of the ward round checklist

Main outcome measures: Adherence to parameters identified in the urology checklist

Results: Stool (23.5%) and pain (30.6%) were worst assessed at baseline, with median 39.3% parameters assessed over all interactions. Significant improvement in assessed parameters after first (median 74.3%), second (median 84.0%), and third cycles (median 100%). These were associated with positive patient outcomes. There was discrepancy between factors verbally addressed and clinically documented (median 84.0% to 57.7% after second cycle). A dedicated third cycle reduced this gap (median 100% to 97%). 100% junior doctors surveyed believed the checklist has enabled addressing of factors which might have otherwise been missed.

Conclusion: The use of a comprehensive, urology-focused, easy-to-memorise ward round checklist is feasible and led to sustained, well-documented improvements in all measured aspects of patients’ care, and perceived level of care by the team.