Re-engineering the cardiology ward round to improve efficiency of care

Type of funding sources: Public hospital(s). Main funding source(s): Flinders Medical Centre and Flinders University.

There is limited literature investigating effective mechanisms improving clinical team cohesion and effectiveness to achieve clinical excellence.

To re-engineer the cardiac care unit (CCU) ward rounds through enhanced cardiac-trained nurse input and advocacy to improve decision-making and deliver patient centred care.

A prospective observational design, ensuring CCU nurse attendance at every ward round (arrhythmia, acute coronary syndrome, heart failure) in consecutive 2-week control and implementation periods, conducted over three 4-week cycles. The primary endpoint was timely administration of cardiac medications. Secondary endpoints were length of stay, time to procedure bookings, patient mobility and education.

206 patients were recruited (control n=101, intervention n=105). Median time to cardiac medication administration was significantly shorter in the intervention cycle, (Intervention:0 hr/med [IQR 0-0.5] versus Control: 0.2 hr/med [IQR 0-1.2],p = 0.012). Heart Failure patients had the most significant improvements; (Intervention 0 hr/med [IQR 0-0.03] versus control 0.9 hr/med [IQR 0.3-1.6], p<0.001). Secondary endpoints trended toward improvement in all ward rounds, but results did not reach statistical significance. See Figure 1.

Empowering CCU nurses on ward rounds reduced medication delays, with clinically valuable improvements in secondary endpoints observed. Further research into implementable and sustainable interventions to drive clinical excellence is essential.

Cardiac Medication Delays