JHQ 313: Improving Job Completion in Acute Medical Units Through Role-Specific Documentation: A Quality Improvement Project-JHQ 313 Article

JHQ 313 Article

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This quality improvement project evaluated whether changing ward-round documentation could improve task (“job”) completion in an acute medical unit (AMU). Prompted by an adverse incident in which a short-term vascular catheter was left in situ because nurses and doctors each assumed the other would remove it—leading to infection—the team aimed to clarify responsibility for daily jobs, reduce missed jobs per patient per day (JPD), and improve adherence to guidance that records should be clear and actionable.<br /><br />From January 26 to April 10, 2024, four foundation year 1 doctors collected retrospective daily data on ward-round jobs: total jobs documented, completed, missed, and number of patients. Two doctors used Standard Documentation (a single “Plan” list), while two used a new Role-Specific Documentation template that separated the plan into “Doctors,” “Nurses,” and “MDT” (multidisciplinary team) headings. Across 606 patients and 2,298 jobs, the standard group recorded 1,291 jobs for 345 patients, and the role-specific group recorded 1,007 jobs for 261 patients. Student’s t-tests were used for comparisons.<br /><br />Role-Specific Documentation significantly reduced missed jobs (147 vs 294; p=0.0002) and increased the proportion of jobs completed (85.74% vs 77.99%; p=0.0003). While the total number of completed jobs did not differ significantly, role-specific plans achieved more completed jobs per patient per day (3.47 vs 2.94; p=0.0052) and fewer missed JPD (0.60 vs 0.82; p=0.0132).<br /><br />The authors conclude that a simple restructuring of documentation to assign tasks by staff role improves completion and reduces missed work, with potential patient-safety benefits and suitability for wider adoption in electronic medical records. Limitations include single-site design, small number of documenters, retrospective/observer bias risks, short duration, and lack of analysis by job type or patient complexity. Future work should assess effects on clinical outcomes and operational metrics such as complications and length of stay.

Keywords

quality improvement project

ward-round documentation

acute medical unit

role-specific task assignment

job completion rate

missed jobs per patient per day

patient safety incident

multidisciplinary team communication

electronic medical records template

vascular catheter removal