title: Republished: Daily consultant gastroenterologist ward rounds: reduced length of stay and improved inpatient mortality.
abstract: BACKGROUND
  For gastroenterology, The Royal College of Physicians reiterates the common practice of two to three consultant ward rounds per week. The Royal Bolton Hospital NHS Foundation Trust operated a 26-bed gastroenterology ward, covered by two consultants at any one time. A traditional system of two ward rounds per consultant per week operated, but as is commonplace, discharges peaked on ward round days.
  
  
  OBJECTIVE
  To determine whether daily consultant ward rounds would improve patient care, shorten length of stay and reduce inpatient mortality.
  
  
  METHODS
  A new way of working was implemented in December 2009 with a single consultant taking responsibility for all ward inpatients. Freed from all other direct clinical care commitments for their 2 weeks of ward cover, they conducted ward rounds each morning. A multidisciplinary team (MDT) meeting followed immediately. The afternoon was allocated to gastroenterology referrals and reviewing patients on the medical admissions unit.
  
  
  RESULTS
  The changes had an immediate and dramatic effect on average length of stay, which was reduced from 11.5 to 8.9 days. The number of patients treated over 12 months increased by 37% from 739 to 1010. Moreover, the number of deaths decreased from 88 to 62, a reduction in percentage mortality from 11.2% to 6%. However, these major quality outcomes involved a reduction in consultant-delivered outpatient and endoscopy activity.
  
  
  CONCLUSIONS
  This new method of working has both advantages and disadvantages. However, it has had a major impact on inpatient care and provides a compelling case for consultant gastroenterology expansion in the UK.
authors.affiliation: Department of Gastroenterology, Royal Bolton Hospital NHS Foundation Trust, Farnworth, Bolton, Lancs, UK. Salil.Singh@rbh.nhs.uk
authors.forename: Salil
authors.initials: S
authors.lastname: Singh
authors.forename: George
authors.initials: G
authors.lastname: Lipscomb
authors.forename: Kadukkavil
authors.initials: K
authors.lastname: Padmakumar
authors.forename: Radha
authors.initials: R
authors.lastname: Ramamoorthy
authors.forename: Shirley
authors.initials: S
authors.lastname: Ryan
authors.forename: Vivien
authors.initials: V
authors.lastname: Bates
authors.forename: Sandra
authors.initials: S
authors.lastname: Crompton
authors.forename: Emma
authors.initials: E
authors.lastname: Dermody
authors.forename: Kieran
authors.initials: K
authors.lastname: Moriarty
mesh_terms: D003253:Consultants; D003362:Cost-Benefit Analysis; D005260:Female; D005762:Gastroenterology / Q000458:organization & administration* / Q000592:standards; D005767:Gastrointestinal Diseases / Q000191:economics / Q000401:mortality / Q000628:therapy*; D006748:Hospital Departments / Q000458:organization & administration; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D009313:National Health Programs / Q000191:economics; D010348:Patient Care Team; D010351:Patient Discharge / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling; D012017:Referral and Consultation; D056164:Teaching Rounds / Q000191:economics; D006113:United Kingdom / Q000453:epidemiology