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iWRAHP: improving the ward round and handover process
  1. Sonpreet Rai1,
  2. Anthony Browning2
  1. 1 Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2 Pinderfields General Hospital, Wakefield, UK
  1. Correspondence to Dr. Sonpreet Rai, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK; sonpreetrai{at}

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Ward rounds were originally intended to educate medical trainees, providing opportunity to examine clinical signs and review symptoms. Over time, they have evolved to focus on supporting clinical practice. The ward round is now a multiprofessional, multifactorial process with healthcare professionals striving to provide high-quality patient-centred care in a reliable, reproducible and timely manner.1 Unfortunately, the effectiveness and efficiency of the ward round has not kept up with the increasing demand on physician time and the rising number of inpatients with more complex medical and social issues.

The aim of improving the Ward Round And Handover Process (iWRAHP) is to deliver safer, faster, better levels of care to urology patients on the ward, aiming to improve patient flow and experience. Through reformatting the ward round process, the focus will be to categorise patients and prioritise the ward round based on their clinical state:

  • Acutely unwell.

  • Suitable for discharge.

  • Stable.

The daily ward rounds will also introduce the concept of ‘real-time working’ of tasks, also known as ‘rounding-in-flow’.2


All healthcare workers involved with patient care on the ward were invited to simulated ward round sessions that ran over the course of 6 weeks. These low-fidelity, multiprofessional, in situ ward round simulation sessions involved two scenarios based around inpatient care. Delegates interacted with a patient actor and were provided with patient notes, observations and drug charts. Delegates …

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  • Contributors SR researched literature and conceived the study. SR and AB were involved in protocol development and implementation. SR wrote the first draft of the manuscript, reviewed and edited the manuscript, and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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