ROLES AND RESPONSIBILITIES OF DOCTORS ON CONTINUING CARE WARDS

 Doctors should set a tone in line with the philosophy of care of the ward which enables
patients to be treated with respect, avoids stereotyping and treats people as
individuals.
 Have developed a clear and open policy defining eligibility for continuing care services.
 Have an understanding of the difficulties presented to the nursing and care staff by
patients with behavioural and psychiatric disturbance in dementia. Be particularly
sensitive to the psychological demands placed on staff who spend a lot of time working
directly with this patient group.
 Have an understanding of the difficulties and anxieties faced by relatives and friends of
the patient.
 Be aware of the potential for many types of abuse of dependent and difficult patients
and be involved in plans and training for prevention, recognition and management of
abuse.
 Visit regularly and frequently. Have a regular time for reviews and make other frequent
ad hoc visits to provide opportunities to discuss problems and successes.
 Psychiatric: understand the complex psychiatric needs and treatment issues of patients
with dementia. Recognize and be able to manage comorbid psychiatric conditions.
 Medical: treat physical conditions within the competence of the psychiatrist. Have
developed liaison plans with robust arrangements in place to manage the interface
between old age psychiatry services and old age medicine.
 Understand the use and misuse of psychotropic medication in dementia. Develop
award policy for the prescription and monitoring of psychotropic.
 Have individual and ward treatment policies available and accessible for out of hour’s
medical cover.
 The patient’s GP will be contacted at the beginning of the admission so that all aspects
of the physical and medication history may be understood.
 Different wards will develop different resuscitation policies depending on the location
of the ward and accessibility to a cardiac arrest team. However, any policy needs to
take into account individual differences between patients and the wishes of their
families. The doctor will be aware that the best course of action is not always to
attempt resuscitation and that in most patients it will be unsuccessful and traumatic
also for the staff involved.
 Adopt a multidisciplinary, multiagency approach to assessment and management and
develop collaborative working relationships to include some joint training initiatives.
  Be cognizant of the interrelationship of biological, psychological and social factors in
the aetiology, presentation and management of mental disorder. Have an
understanding of psychosocial aspects of dementia and a willingness to use nonmedical
treatments.
 Support mechanisms for patient representation and advocacy.
 Have a detailed understanding of issues of consent and capacity in relation to dementia
and the appropriate use of legislation. For those who lack capacity the doctor will at all
times act in the patient’s best interests.
 Patient information will be treated as confidential. Information about patients without
capacity to agree to disclosure may nevertheless be shared with close family if it is
considered to be in the patient’s best interests. Sensitive judgments may be required if
the patient and/or family are in conflict.
 Have a consistent emphasis on staff support, supervision, education and training.
 Develop a critical self-awareness of emotional responses to disabled and dependent
patients.
 Have a basic understanding of group/team dynamics.
 Ensure that systems are in place for the support of patients’ families and friends.
Recognize that the needs and wishes of patients and their families although often the
same do not always coincide.
 Be able to consider moral and ethical dilemmas at the end of life and be able to discuss
these where appropriate with patients and families.
 Develop a scheme for ward reviews which encompasses all aspects of a patient’s life.
Each ward and team will develop their own scheme. Some will prefer the use of
standardized rating scales, others free discussion. Each long stay patient will be
reviewed by the ward doctor three monthly and at a ward review with a senior doctor
six monthly or more frequently if there are problems. The multidisciplinary team will
know who is scheduled for review and be ready to discuss the patient.

The ward doctor will have examined the patient beforehand and results of any appropriate
investigations will be to hand for the review.

Family members, partner or close friend may be invited to discuss aspects of the patient’s care
and particularly contribute to drawing up a plan of action for when/if the patient becomes
physically unwell.

Areas for presentation and discussion may include the patient’s -

 Current cognitive and psychiatric condition

  Current physical condition
 Medication review
 Resuscitation and treatment plans for the future
 Functional abilities
 Behavior
 Care needs
 Communication skills
 Activities
 Pleasures and preferences
 Cultural and religious needs
 Family
 Finances and possessions
 Strengths
 Ensure that complete, understandable and legible records are kept of clinical
Assessments and decisions.
 Actively continue to learn and develop professionally and be aware of contemporary
Clinical advances.

• Develop an understanding of how services are planned and managed within the NHS, in
collaboration with other partner agencies, e.g. social services.

25 Healthcare Metrics & KPIs

1. Patient Wait Time: Calculates the average amount of time a patient must wait
between checking in and seeing a provider. This can help with staffing and scheduling
and provide insight into patient satisfaction.
2. Average Number Of Patient Rooms In Use At One Time: Shows how well space is used
to treat patients and helps determine if more or less space is needed in the facility.
Think about this as an occupancy rate, like at a hotel.
3. Staff-To-Patient Ratio: Indicates the use and capacity of staff resources, which can
affect the quality of patient care.
4. Bed Or Room Turnover: Demonstrates how fast patients are moving in and out of the
facility. This affects the efficiency of the facility and should be considered when
looking at patient satisfaction. You might want to consider tying this one closely with
readmittance rates to make sure you that you are not letting people leave the facility
who are not well.
5. Communication between Primary Care Physician, Proceduralist, & Patient:
Determines how frequently various parties are in communication with one another,
 increasing the quality of care for the patient. This is sometimes measured by
satisfaction, and sometimes measured by the number of documented communication
activities.

Finance

6. Average Insurance Claim Processing Time & Cost: Averages the amount of time and
money an organization spends processing insurance claims. When low, it indicates that
the facility receives payment faster and there is less cost to the patient.
7. Claims Denial Rate: Provides insight into the effectiveness of the organization’s
revenue cycle. A low claims denial rate means that the organization has more time to
focus on patient care and spends less time on paperwork.
8. Average Treatment Charge: Shows the average amount that a facility charges a
patient for a treatment. It can be broken down by treatment or shown as an average
of all treatments or treatment categories.
9. Permanent Employee Wages: Records the value of wages (including bonuses) paid to
all full-time employees during the reporting period. This is sometimes separated out
by administration, and sometimes by direct providers of care.

Communications

10.Number of Media Mentions: Keeps track of how often you’re mentioned in the media,
which could include news outlets as well as social media. You may want to consider
tracking positive and negative mentions separately.
11.Overall Patient Satisfaction: Calculates satisfaction levels by combining several
factors. This can be a great marketing tool for your organization if it’s high, but a low
number could signal a problem with other operations or services.
12.Percentage of Patients Who Found Paperwork To Be “Clearly Written &
Straightforward”: Demonstrates whether a healthcare organization has ensured that
written materials have clear instructions that patients can understand easily and
respond to.

Internal

13.Trainings per Department: Tracks the amount of training each department provides or
requires of their staff.
 14.Number of Mistake Events: Measures the number of mistakes made in the
organization, which can be tracked by mistake category. This can indicate the
effectiveness of the employees and the equipment.
15.Patient Confidentiality: Measures the number of times a patient’s confidential
medical records were compromised or seen by an unapproved party.
16.Number of Partnerships with Advocacy Groups: Counts the number of relationships
established with other organizations. A high number of partnerships can increase the
impact of campaigns and policy events.

Public Health

17.Childhood Immunizations: Demonstrates the number of children who have received

immunizations, which reflects your contribution to overall community health.
18.Number of Educational Programs: Indicates the time and effort put into educating the
public. This can be broken down into the type of program as well as the target
audience for each program.
19.Number of Preterm Births: Counts the number of preterm births (under 37 weeks)
that have occurred in the region.

Emergency

20.Patient Wait Times By Process Step: Shows the amount of time a patient must wait
during their visit to the emergency area of the facility.
21.Time between Symptom Onset & Hospitalization: Gauges the amount of time
between when a patient begins experiencing symptoms and when they were
hospitalized.
22.Number of Visitors (Patients) Who Leave without Being Seen: Indicates the number
of people who were unwilling to wait to see a physician. This may help determine if
more beds or staff is needed to handle the number of patients coming in.

Care

23.Medication Errors: Measures the number of times there is an error in prescribing

medication at the facility. This includes when a mistake is made in the medication,
patient, or dosage, and it applies to both inpatient and outpatient services.
24.Patient vs. Staff Ratio: Demonstrates the number of staff available per patient. May
indicate whether the facility is overstaffed or understaffed.
25.Patient Follow-Up: Measures the number of patients who receive follow-up after their
visit to the facility. This could be from a physician, nurse, or other staff member asking
about the visit and the patient’s improvements.