title: Improving the quality and safety of care on the medical ward: A review and synthesis of the evidence base.
abstract: Despite its place at the heart of inpatient medicine, the evidence base underpinning the effective delivery of medical ward care is highly fragmented. Clinicians familiar with the selection of evidence-supported treatments for specific diseases may be less aware of the evolving literature surrounding the organisation of care on the medical ward. This review is the first synthesis of that disparate literature. An iterative search identified relevant publications, using terms pertaining to medical ward environments, and objective and subjective patient outcomes. Articles (including reviews) were selected on the basis of their focus on medical wards, and their relevance to the quality and safety of ward-based care. Responses to medical ward failings are grouped into five common themes: staffing levels and team composition; interdisciplinary communication and collaboration; standardisation of care; early recognition and treatment of the deteriorating patient; and local safety climate. Interventions in these categories are likely to improve the quality and safety of care in medical wards, although the evidence supporting them is constrained by methodological limitations and inadequate investment in multicentre trials. Nonetheless, with infrequent opportunities to redefine their services, institutions are increasingly adopting multifaceted strategies that encompass groups of these themes. As the literature on the quality of inpatient care moves beyond its initial focus on the intensive care unit and operating theatre, physicians should be mindful of opportunities to incorporate evidence-based practice at a ward level.
authors.affiliation: NIHR Patient Safety Translational Research Centre, Imperial College London, and West Middlesex University Hospital NHS Trust, UK. Electronic address: S.Pannick@imperial.ac.uk.
authors.forename: Samuel
authors.initials: S
authors.lastname: Pannick
authors.affiliation: West Middlesex University Hospital NHS Trust, UK. Electronic address: Iain.beveridge@wmuh.nhs.uk.
authors.forename: Iain
authors.initials: I
authors.lastname: Beveridge
authors.affiliation: Division of Hospital Medicine, University of CA, San Francisco, USA. Electronic address: bobw@medicine.ucsf.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Wachter
authors.affiliation: NIHR Patient Safety Translational Research Centre, Imperial College London, UK. Electronic address: n.sevdalis@imperial.ac.uk.
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
mesh_terms: D003299:Cooperative Behavior; D006760:Hospitalization; D006801:Humans; D033183:Interdisciplinary Communication; D015279:Organizational Culture; D005791:Patient Care / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration*; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling; D058996:Quality Improvement; D011787:Quality of Health Care
keywords: Delivery of health care; General wards; Inpatients; Patient safety; Quality of health care