Improving the efficiency of clerking patients under an acute medical admission by introducing allied healthcare professionals to the clerking process

Abstract

Introduction: The acute medical clerking process is a critical stage of a patient's hospital journey, with evidence suggesting its positive impact on patient outcomes. [1,2] The development of clerking pro-formas, recommended by the Royal College of Physicians, produces an improved completeness of essential information. [3] However, clerking pro-formas have led to an increased documentation load for clerking physicians, subsequently impacting the time taken to assess, diagnose and initiate management plans. This, in turn, may delay patient assessment by acute medical physicians once accepted under the take.Though there are several factors that may impair physicians’ abilities to perform their roles, including frequent interruptions and seniority, observational studies indicate that documentation takes up the largest proportion of time, approximately 25–40%. [4,5] Our project aims to explore a strategy to reduce the documentation time taken for clerking physicians. The aim was to determine whether the addition of allied healthcare professionals (HCPs) increases the efficiency of admitting patients to hospital by decreasing the time taken to complete documentation as well as decreasing the number of patients waiting to be seen at the start of each subsequent handover. Method: The project measured the start and end times for a junior doctor clerking a patient. This time included documenting a patient's medical history, medications, allergies, social history, investigation results as well as their current presentation. Data was recorded when (i) a patient was admitted to the medical team and clerked solely by the admitting physician, and (ii) when a patient was admitted to the medical team and clerking documentation was completed by an allied HCP.In cases where an allied HCP assisted in completing clerking documentation, the start time was recorded when the clerking physician received the appropriate information from the HCP prior to seeing the patient. Discussion: Data was collected from 110 patients needing hospital admission. 55 were clerked by a doctor alone and 55 patients were admitted by a doctor whose documentation was supported by an allied HCP.The average time taken to admit patients was 51 minutes, compared to 22 minutes when HCPs assist with documentation. This shows a 57% reduction in the time taken to clerk with the assistance of allied HCPs. Furthermore, the number of patients awaiting clinical review and clerking at subsequent handovers were reduced by 2.5 times.This data highlights a substantial improvement in the efficiency of clerking physicians when supported by allied HCPs in completing clerical documentation. Conclusion: Our project shows that the inclusion of allied HCPs significantly reduces the time taken for the clerking process while ensuring the appropriate completion of medical clerking pro-formas. We therefore recommend the continued involvement of allied HCPs in the medical take to assist with documentation as this approach has the potential to streamline processes and enhance overall efficiency. We hope that this quality improvement project provides strong foundations for further studies to assess the qualitative impact on Acute Medical Units, promoting continuous advancement in patient care and hospital workflow.