Improving Family Updates on a Complex Care Geriatrics ward: A Quality Improvement Project

1. Introduction 

Communication between clinical teams, patients and their families is an essential aspect of patient-centered care. This is particularly important in geriatric medicine where our patients may be less able to update their families themselves.  A friends and family survey on the complex-care ward highlighted shortcomings in the family update process. 

2. Method 

Baseline data was collected and analyzed from the notes of 33 patients on the complex-care ward, including the number of documented family updates per patient and whether an update occurred within 48 hours of arrival to the ward. Using QI methodology, our aim was to increase the average number of family updates from the baseline.  Our intervention was a designated update logbook in the front of the patient notes prompting the clinical team to update patients' relatives within 48 hours of arrival to the ward and regularly thereafter.  

3. Results 

Baseline data revealed a significant portion of relatives received few or no updates during their admission. There were large inconsistencies in communication practices between clinicians. Following the introduction of a 'family update logbook' the average number of documented updates per patient per length of stay improved from 1.7 to 2.6, suggesting a positive effect from the use of a logbook in the patient notes.  No improvement was seen to early relative communication in the first 48 hours of admission. 

4. Conclusions  

A family update logbook can be a useful tool for staff to identify patients whose relatives require updating, leading to more holistic patient centered care. Future applications of this project could include an electronic logbook, as the trust moves to an electronic notes system. This could create a more efficient way of documenting updates, as well as having the potential to electronically flag patients whose relatives have not been updated.