• Salil Singh, George Lipscomb, Kadukkavil Padmakumar, Radha Ramamoorthy, Shirley Ryan, Vivien Bates, Sandra Crompton, Emma Dermody, and Kieran Moriarty.
• Department of Gastroenterology, Royal Bolton Hospital NHS Foundation Trust, Farnworth, Bolton, Lancs, UK. Salil.Singh@rbh.nhs.uk
• Postgrad Med J. 2012 Oct 1; 88 (1044): 583-7.

BackgroundFor 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.ObjectiveTo determine whether daily consultant ward rounds would improve patient care, shorten length of stay and reduce inpatient mortality.MethodsA 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.ResultsThe 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.ConclusionThis 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.

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