A pilot study to assess the utility of a ‘sterile cockpit’ on the quality of the Surgical Ward Round

The ‘sterile cockpit’ intervention will involve enforcing no interruptions/distractions and essential activities only in the ward round, it also involves asking the nursing and allied health staff if they had any questions or concerns, and asking the scribe to repeat back the plan at the end. Patients involved in this study receive normal surgical care throughout the duration of their stay from all members of the team (nursing staff, allied health, doctors). All staff will be trained in the 'Sterile Cockpit' design, and patients in the intervention group will experience a modified rounding experience. This 'Sterile Cockpit' design seeks to focus the doctors discussion more on the patient, and does not change the normal process that would occur in the ward round. To assess the intervention, investigators perform medical case note review, and compare the case notes to audio-visual footage of the spoken discussion. This study is not randomised and was selected based on convenience sampling. Therefore, all patients who did not have gastroenteritis, were not on contact precautions and were over the age of 18 with the capacity to consent were approached and asked about their participation in the trial. For the Sterile Cockpit intervention, an education session was given to all members of staff one week before the intervention began. This consisted of a 20 minute presentation, followed by 10 minutes of question time.This involved a powerpoint presentation of the problems, aims, and step-by step methodology of how to conduct the Sterile Cockpit. Staff were consistently reminded by study investigators to adhere to the Sterile Cockpit design. The only physicial material that was used was a 'Do Not Disturb' sign which was placed outside the patients door while the team was speaking to the patient. The intervention was carried out by any member that was on the Surgical team (nursing staff, dietician, intern, RMO, Registrar, consultants) with the team leader (most senior in the group) taking on the responsibility to ensure that the Sterile Cockpit ran smoothly. The Intervention was performed every day consecutively in person until the target number (n=70, as per biostatistician power calculation) was achieved. A patient was exposed to the 'Sterile Cockpit' ward round each day during their inpatient admission. Each morning, the team would check with the patient that they were still happy to participate. The ward rounds run every morning for approximately one hour. To measure adherence of the intervention, study investigators collected the following datapoints from the audio-visual recording: 'whether the nurse was present', whether the nurse or allied health team was asked for their input', 'the number of parallel conversations', ' the number of distractions' and if the intern repeated back the plan to the team at the end.