title: Identifying quality markers and improvement measures for ward-based surgical care: a semistructured interview study.
abstract: BACKGROUND
  The surgical ward round (WR) represents the primary interface between the clinical team and the patient and is integral to the quality of postoperative care and subsequent patient outcomes. This study aims to explore key issues pertaining to the surgical WR, defining challenges in current practice, and identifying potential means of quality assessment and improvement.
  
  
  METHODS
  A qualitative, semistructured interview-based approach was adopted, including patients, nurses, interns, residents, and attendings.
  
  
  RESULTS
  Twenty-five interview subjects were recruited across 8 hospitals. Twenty-three of the 25 (92%) subjects believed that there was significant variation in the quality of WRs and that this affected patient care. Lack of thoroughness (18/25, 72%) and poor communication (12/25, 48%) were the most commonly identified causes. Nontechnical skills such as communication (25/25, 100%) were seen as crucial to WR quality. Quality markers for surgical WRs were identified. Simulation-based training was recommended (13/25, 52%) to improve performance.
  
  
  CONCLUSIONS
  Clinical staff and patients alike perceive there to be significant variability in current surgical WR practice. Further development of interventions to assess and improve surgeons' performance is necessary to standardize and improve WRs and patient care.
authors.affiliation: Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, London, UK. Electronic address: p.pucher@imperial.ac.uk.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Pucher
authors.affiliation: Department of Surgery, McGill University, Montreal, Canada; Arnold & Blema Steinberg Medical Simulation Centre, Faculty of Medicine, McGill University, Montreal, Canada.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.affiliation: Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, London, UK.
authors.forename: Pritam
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, London, UK.
authors.forename: Muaaz
authors.initials: M
authors.lastname: Tahir
authors.affiliation: Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, London, UK.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D013503:Surgery Department, Hospital; D013514:Surgical Procedures, Operative / Q000592:standards*
keywords: Patient round; Postoperative care; Quality improvement; Surgery; Ward round