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Standard forms for weekend management increase inpatient safety

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A pilot study in a district general hospital in the UK has found that introducing a standard form to regularise inpatient management at weekends improved care and safety.

Documentation was better, with significantly more inpatients having a weekend plan in their notes and a recorded resuscitation decision, though recorded decisions on prophylaxis for deep vein thrombosis (DVT) were significantly fewer, maybe because the form did not specify this. The number of patients reviewed over a weekend was not affected.

Doctors found the form user friendly and helpful, and nurses, especially, valued it for briefing on call doctors unfamiliar with a patient. More generally, the form provided a useful prompt for resuscitation decision to be reviewed over time.

The form was based on an initial audit of the notes of 33 randomly chosen medical inpatients for one weekend to determine criteria that should be covered and was suitable for all medical specialties. Three months after its introduction a reaudit was performed on the notes of 273 inpatients. The form is now being applied to surgical patients.

Weekends are a critical time for patients as there is no regular clinical review. Research shows that this is a time of greater risk of avoidable heart attacks and deaths, so good communication among healthcare professionals is paramount. Local guidelines state that weekend plans should be in place, recording decision on resuscitation, on prophylactic treatment for DVT, and expected discharge date, for on call teams to refer to. The next step is to determine whether the form has improved clinical decisions at weekends.