Table 1

Board round clinical protocol

	PDSA-0: Baseline	PDSA-1: Months 1–3	PDSA-2: Months 4–12
Ward round	Emergency general surgery consultants do a post-take ward round at 8:00 hours Every weekday morning and afternoon each general surgery on-call consultant firm performs a separate ward round led by the specialist trainee surgeon for their listed patients. Elective specialist digestive surgery: ward round attended by senior clinicians twice weekly. Physiotherapists, social workers, pharmacists and other multispecialty staff attend the ward daily and provide their input separately and independently.	Twice daily trainee surgeon led: 8:00, 16:00 hours Twice weekly consultant led	No change
Daily communication Surgical team=>Nurse in charge	Unspecified	Junior doctors under trainee surgeon supervision, give the following handover items to the nurse in charge by 15:00 hours Named consultant Current reason for admission Scheduled listed actions for tomorrow Revised discharge date Nurse in charge to include the above in the evening nurse handover
Monday–Friday board round		Daily 10:00–10:30 hours Led by nurse in charge Chaired by one of the three project-leading consultant surgeons and the dedicated specialist nurse. Attended by physiotherapist and social worker, community liaison. Once weekly attended by service manager, pharmacist, matron nurse, divisional patient flow nurse coordinator	Chaired by the post-take consultant of the day, board rounds made part of the post-take job plan. Also attended by post-take surgical trainee.
For each patient discussing		The clinical handover items Discharge plan within 24 hours Rehabilitation need Likelihood of complex discharge team involvement Need for aftercare package Red or green day