Quality Improvement Project: Improving Multidisciplinary Meeting Documentation on Older Person Wards with an EPIC SmartPhrase

Background

A quality improvement project was undertaken on inpatient wards in the Ageing and Health department of Guy’s and St Thomas’ NHS Foundation Trust. The patient group comprised older adults predominantly living with frailty and multimorbidity. Care is delivered by a multidisciplinary team (MDT) including resident doctors, consultants, nurses, physiotherapists, occupational therapists, speech and language therapists (SALT), dieticians, and discharge coordinators.

Introduction

Reliable documentation of multidisciplinary meetings (MDMs) contributes to safe, coordinated and patient-centred care. Locally, MDT members identified variation in the quality of MDM documentation with inconsistent recording of core components, including nursing, therapy, and discharge updates. This project aimed to improve the accuracy and consistency of MDM documentation and to increase resident doctors’ confidence when documenting MDT discussions.

Methods

A baseline retrospective audit of 30 MDM entries from the pilot ward was conducted in October 2025. Documentation standards were agreed with MDT members and included having an update from each discipline involved in the patient’s care and documented estimated discharge dates (EDD).

PDSA Cycle 1 involved development and implementation of an EPIC MDM SmartPhrase that auto-populates MDT updates from existing flowsheets, prompts discussion of key domains, and supports real-time EDD updating. A re-audit was undertaken three weeks post implementation on the pilot ward.

PDSA Cycle 2 expanded the use of the SmartPhrase to two wards in November 2025 and incorporated an MDT survey assessing perceived documentation quality, preparation time and resident doctor confidence in documenting meetings pre- and post-intervention.

Results

Post-intervention audit demonstrated improved documentation of MDT input across all disciplines except SALT and dieticians, 100% documentation of updated EDDs, and no increase in MDM duration. Lower uptake from SALT and dieticians was attributed to flowsheets not being part of their routine practice. Survey responses showed improved perceptions of documentation quality, limited impact on meeting preparation time and increased confidence among all resident doctors in documenting MDT discussions.

Conclusion

An MDM-specific SmartPhrase improved documentation quality and resident doctor confidence in documenting. Structured, consistent records support coordinated care and discharge planning. Sustainability depends on ongoing MDT engagement and routine flowsheet use, with planned departmental roll-out accompanied by training sessions for new users at induction sessions.