Abstract

Quality Improvement Project : Enhancing Stroke Unit Ward Round Documentations in a Large District Hospital

Author Name - T Han; R Ehsan; A T Moe; K S Tun; D Ramsey

Provenance - Princess Royal University Hospital

Background

This improvement project was undertaken within the Stroke Unit (SU) at Princess Royal University Hospital under King’s College Hospital NHS Foundation Trust. The multidisciplinary stroke team includes consultants, registrars, junior doctors, nurses, and therapists. Patients are typically admitted from the Hyperacute Stroke Unit (HASU) following initial stabilisation and thrombolysis/thrombectomy when appropriate.

Introduction

Following the Trust-wide implementation of the EPIC electronic patient record system in October 2023, it became apparent that the standard ward round template lacked stroke-specific fields. This omission led to inconsistent documentation of key clinical information—such as stroke type, aetiology, investigations, and treatment escalation plans—which are essential for safe handover and continuity of care. Our goal was to ensure all essential clinical information was consistently documented during stroke ward rounds.

Methods

We conducted a retrospective review of 100 sets of ward round notes (50 pre- and 50 post-intervention) from patients admitted to SU between November–December 2024 and March–April 2025. Key documentation criteria were agreed upon following consultation with the stroke consultant team. The data were collected and analysed against predefined standards. A full PDSA cycle was completed to guide the intervention.

Interventions

We developed and implemented a stroke-specific "SmartPhrase" template within EPIC to prompt documentation of critical stroke elements. The template included structured fields to support efficient completion. The intervention was shared via departmental meetings and regular reminders to clinicians.

Results

Post-intervention, documentation improved across all areas: stroke summary (34% to 78%), relevant investigations (66% to 94%), VTE plans (46% to 78%), and escalation planning (24% to 42%). This enhanced communication and supported safer handovers. We aim to reach 100% compliance by encouraging all new resident doctors to use the SmartPhrase, supported by senior clinicians.