Title : Digitising multidisciplinary documentation to improve clinical communication and patient flow: A quality improvement initiative at a high-performing district general hospital
Abstract:
Background: Ealing Hospital, part of London North West University Healthcare NHS Trust (LNWUH), performs strongly in national hip fracture metrics. Despite this, internal feedback revealed ongoing challenges with fragmented multidisciplinary documentation, lack of real time updates, and uncertainty regarding the most up-to-date management plans. These issues were associated with discharge delays, inconsistent decision-making, and increased reliance on Temporary Escalation Spaces (TES).
Methods: A digital board round tool was co-developed with the multidisciplinary team (MDT) and piloted on orthopaedic wards for patients with fragility femoral fractures. The tool was designed to standardise documentation of key clinical milestones across the inpatient journey, from pre-operative assessment through to post-operative recovery and discharge planning. A multidisciplinary staff survey assessed baseline perceptions of documentation clarity and communication efficiency.
Results: The lowest-rated domains in the MDT survey were investigation tracking (mean score 2.50) and documentation of post-operative progress (2.63), reflecting concerns about poor visibility of outstanding diagnostics and inconsistent recording of patient recovery. Free-text feedback reinforced these gaps, with staff highlighting difficulties in locating relevant updates and unclear management decisions. These documentation shortcomings were perceived to delay care coordination, increase reliance on verbal handovers, and hinder timely discharge planning. Post-intervention outcome data collection is ongoing, focusing on discharge timing, length of stay, and MDT-reported communication quality.
Conclusion: This digital documentation intervention shows strong potential to enhance real time visibility of inpatient progress, streamline communication, and reduce discharge delays in orthopaedic care. Its implementation aims to address longstanding challenges related to fragmented MDT input and unclear clinical planning. Pending demonstrable improvements in post-intervention outcomes, the project has secured both clinical and operational support for scale-up across the entire surgical division at London North West University Healthcare NHS Trust. It is anticipated that post-intervention data will demonstrate the initiative’s contribution to Trust priorities, including reducing inpatient length of stay, increasing pre-5pm discharges, and minimising reliance on TES.
