Omitting repetitive clerking does not disadvantage cardiology patients and reduces duplication

Area of Science:

• Cardiology
• Healthcare Quality Improvement
• Hospital Administration

Background:

• Nottingham University Hospital's cardiology department manages approximately 320 monthly emergency department (ED) admissions, predominantly out-of-hours.
• Current protocol involves initial clerking by ED physicians and the cardiology advanced nursing team (CATS), followed by re-clerking by an on-call junior doctor (JD) upon transfer.

Purpose of the Study:

• To evaluate the benefits of eliminating the redundant clerking of cardiology patients by junior doctors (JDs).

Main Methods:

• A quality improvement project compared CATS team clerking and plans against JD plans for 100 cardiology admissions.
• Reviewed the time spent by nine JDs on traditional clerking versus an alternative method involving JD review of CATS clerking, data, and nursing discussion.
• Assessed changes in management plans and critical interventions in both methods.

Main Results:

• Management plans were altered in only 5% of cases when JDs reviewed existing clerking, indicating minimal impact.
• The average time for JD clerking decreased significantly from 49.5 minutes to 12.5 minutes with the new method.
• Nursing staff escalated three cases, two of which led to initiating oral antibiotics, highlighting continued clinical vigilance.

Conclusions:

• Omitting repetitive clerking by junior doctors (JDs) is safe for cardiology patients and significantly improves JD efficiency.
• The revised admission process saves valuable time for on-call JDs and avoids unnecessarily waking patients overnight, potentially reducing delirium risk.
• Rationalizing the hospital admission system is recommended based on these findings.