Improving Opportunities for Patients to Raise Concerns During Ward Rounds: A Quality Improvement Project

Introduction Martha's Rule was introduced following the death of 13-year-old Martha Mills, whose signs of sepsis were overlooked despite concerns raised by her parents. It can often be difficult to voice concerns in a busy clinical setting, but one key opportunity for them to be addressed is the daily ward round. Aims This study aimed to increase the proportion of patients and relatives asked about concerns, to increase the proportion of concerns addressed by doctors, and to identify discrete types of concerns raised. Methods We observed 15 ward rounds between October 2024 and February 2025 and documented interactions using a premade observational tool. "Intervention 1" provided patients with colour-coded prompt cards assessing their conditions and concerns. "Intervention 2" briefed doctors to ask patients about their concerns. Data was evaluated using both quantitative and qualitative methods. Quantitative data were analysed using run charts to assess trends and variation over time, with median values used as a reference line to identify shifts and patterns. Qualitative responses were categorised and presented using pie charts to illustrate the distribution of themes and proportions. Results Pre-intervention observations showed that, though concerns raised were mostly addressed, doctors often failed to explicitly ask about concerns. Intervention 1 was discontinued due to poor patient engagement. Run chart analysis demonstrated improved communication following Intervention 2, with the proportion of patients directly asked about their concerns increasing from 2/8 (25%) to 17/20 (85%) pre-intervention to 9/9 (100%) at its peak. The proportion of concerns addressed during ward rounds remained high throughout and reached 7/7, 9/9, and 8/8 (100%, 100%, and 100%), over three consecutive days post-intervention. Symptom-related concerns were the most common both before and after the intervention, suggesting that the intervention improved the communication of concerns rather than altering their nature. Intervention 2 increased the proportion of patients asked about their concerns but did not affect the proportion of concerns addressed. Common concerns elicited were "pain", "other symptoms", "equipment", and "discharge plans", which remained unchanged post-interventions. Conclusion Intervention 2 had the most positive effect in prompting doctors to ask patients about concerns but remains unsustainable. This project highlights the challenges around patient engagement during ward rounds and the need for consistent data collection surrounding interventions. Alternative and sustainable solutions to promote patient participation in their care may need to be considered.