Optimising Patient Flow Through Effective Board Rounds

Introduction

Effective patient flow is critical for the safe and efficient operation of any acute hospital. Delays in discharge, transfers, or access to diagnostics not only impact individual patient care but also create upstream bottlenecks, leading to increased waiting times in emergency departments and cancelled elective procedures. Board rounds, when structured and facilitated correctly, serve as a pivotal mechanism for multidisciplinary teams to collectively manage patient journeys, identify barriers, and proactively plan next steps.

Why this topic matters

Poor patient flow contributes to significant pressures within the NHS. It can lead to 'corridor care,' breaches of target waiting times, increased risk of hospital-acquired complications, and staff burnout. Data from NHS England and national audits consistently highlight the impact of delayed discharges on bed occupancy and emergency care performance.

Optimising board rounds offers a tangible opportunity for teams to regain control of patient pathways. By ensuring clear communication, shared understanding of patient status, and proactive problem-solving, hospitals can unlock potential capacity, improve patient safety, and enhance the overall quality of care. This is not merely an operational exercise; it is a clinical safety imperative.

Practical explanation

A board round is a structured, multidisciplinary meeting, typically held daily (often more frequently in busy areas), where the healthcare team reviews each patient under their care. The core purpose is to:

• Review patient progress: Assess current clinical status and response to treatment.
• Plan next steps: Outline investigations, treatments, or interventions required.
• Identify barriers to flow: Recognise and address issues delaying discharge or transfer (e.g., social care assessments, transport, medication supply, diagnostics).
• Set expected date of discharge (EDD): Proactively plan for discharge from admission.
• Allocate responsibilities: Clearly assign tasks and follow-up actions.
• Prioritise care: Ensure urgent needs are met and resources are allocated appropriately.

Key participants typically include medical staff (consultants, registrars, junior doctors), nursing staff (ward sisters/charge nurses, ward nurses), allied health professionals (physiotherapists, occupational therapists), pharmacists, and discharge coordinators. The presence of social care representatives can be particularly beneficial for complex discharges.

Core elements of an effective board round:

1. Structure and Pacing: A consistent agenda and a skilled facilitator (often a consultant or senior nurse) are crucial. Each patient discussion should be concise and focused, aiming to cover key information and decision points efficiently.
2. Multidisciplinary Input: Active participation from all relevant disciplines ensures a holistic understanding of the patient's condition and needs, preventing silos of information.
3. Visual Aids: A 'board' (physical or digital) displaying key patient information (e.g., name, age, primary diagnosis, EDD, current barriers, responsible clinician) helps maintain focus and track progress.
4. Action Orientation: The output of each patient discussion should be clear, actionable tasks with assigned owners and deadlines. It's not just about noting problems but solving them.
5. Proactive Discharge Planning: From the moment of admission, discharge should be considered. Setting and regularly reviewing EDDs drives a proactive approach to identifying and addressing potential delays early.

Common pitfalls

Despite their importance, board rounds can become ineffective if certain pitfalls are not avoided:

• Lack of structure or facilitation: Rambling discussions without clear objectives or an inability to keep discussions focused can waste valuable time.
• Insufficient multidisciplinary attendance: Missing key professionals (e.g., AHPs, pharmacists) can lead to incomplete plans and delays.
• Information silos: Lack of shared information or preparation can result in redundant discussions or missed critical details.
• Focus on 'presenting' rather than 'planning': Spending too much time detailing current status without identifying next steps or discharge barriers.
• No clear actions or accountability: Decisions made during the round are not recorded or followed up, leading to repeated discussions the next day.
• Ambiguous EDDs: Failing to set or update EDDs, or setting unrealistic ones, reduces the impetus for proactive discharge planning.
• Digital system limitations: Inefficient digital systems that hinder rapid access to relevant patient information or easy updates can slow down the process.

Step-by-step approach to optimising your board rounds

1. Pre-Board Round Preparation

• Identify Participants: Ensure essential multidisciplinary team members are available and understand their role.
• Gather Key Information: Nursing and medical teams should pre-populate the board (digital or physical) with up-to-date patient information, including EDD, key investigations, and known barriers.
• Assign Facilitator: A senior clinician or nurse should be designated to chair the round, keeping it focused and action-oriented.

2. During the Board Round

• Structured Review: Go through each patient systematically. A typical format might be: 'Who is the patient? What is the main problem? What have we done? What needs to happen next? What is the EDD, and what are the barriers to achieving it?'
• Active Participation: Encourage all disciplines to contribute their unique insights into patient care and potential delays.
• Focus on Actions: For each patient, clearly define the next steps, assign responsibility, and note any required follow-up.
• Prioritisation: Address patients with immediate issues or those close to discharge with urgency.
• Barrier Identification and Escalation: Explicitly identify and discuss barriers to discharge. Where resolution is not possible within the team, agree on an escalation pathway.
• Review EDDs: Challenge and update EDDs regularly. If the EDD is missed, understand why and update it with a new, realistic target.

3. Post-Board Round Actions

• Communicate Decisions: Ensure all team members, especially those not present, are aware of decisions and assigned actions.
• Update Patient Records: Document key decisions and plans in the electronic patient record (EPR) or care notes.
• Follow-up on Actions: Ward staff and discharge coordinators should actively pursue and complete assigned tasks throughout the day.
• Monitor Progress: Regularly track against EDDs and review unresolved barriers in subsequent rounds. This helps to identify systemic issues requiring higher-level intervention.

Example in clinical practice

Consider an acute medical ward struggling with delayed discharges, characterised by high bed occupancy and frequent emergency department breaches. The ward team decides to review and improve their daily board rounds.

Previously: Rounds were often informal, led mainly by junior doctors, with inconsistent attendance from therapists or pharmacists. EDDs were rarely updated, and actions were not always clearly assigned. Discussions frequently revolved around clinical presentations with less focus on discharge planning.

New Approach:

1. Preparation: The ward sister ensures the digital board is updated with patient demographics, a preliminary EDD (set on admission), and a 'discharge readiness' status for each patient by 8 am.
2. Attendance: The Consultant acts as facilitator. The multidisciplinary team (MDT) including a physiotherapist, occupational therapist, pharmacist, and discharge coordinator attend punctually.
3. Structured Discussion: Each patient is discussed for a maximum of 2 minutes. The focus is on: 'What is holding this patient up from going home today or tomorrow?'
4. Action Focus: For a patient awaiting a social care assessment, the discharge coordinator immediately flags this, and a task is assigned to follow up directly with the social work team by 10 am. For a patient needing new medication reconciled before discharge, the pharmacist agrees to review and action this straight after the round.
5. Visual Management: The digital board clearly displays the EDD, the person responsible for the next key action, and the expected completion time. Patients with an overdue EDD are highlighted.

Outcome: Within weeks, the ward sees a reduction in average length of stay and fewer delayed discharges. Staff report improved clarity on patient plans and reduced frustration, as barriers are identified and addressed earlier. The potential capacity released supports improved patient flow from the emergency department.

How Lazomis can help

Lazomis offers tools that can significantly enhance the effectiveness of your board rounds. Our QI Project Setup module can guide you through a structured improvement project to design and implement optimal board round processes, including identifying baseline metrics and measuring impact. The Data Collection and Audit features allow for systematic tracking of key indicators such as EDD accuracy, time spent in board rounds, and the resolution rate of identified barriers, providing the evidence base for ongoing refinement.

Furthermore, our Dashboard functionality can help visualise ward-level flow metrics, linking board round efficiency directly to outcomes like bed days lost to delayed discharge. While Lazomis does not replace your hospital's EPR, it can complement it by providing a framework to manage the continuous improvement cycle for patient flow initiatives.

This resource supports, but does not replace, clinical judgement. Local policy, formulary and specialist advice should be followed.