Table 2.

Summary of findings and limitations of included studies utilising a ward round checklist or proforma

First author (year)	Intervention	Method of implementation	Improved documentation/adherence	Patient satisfaction	Staff satisfaction	Limitations
Al-Mahrouqi (2013)	Post-acute ward round proforma/checklist	Standardised ward round proforma introduced as a sticker attached to a patient’s notes, and implemented for 6 months prior to post-intervention data collection	Improvement in documentation of time and date (37% vs 72%) and impression (40% vs 61%); improvement in documentation of dietary plan when proforma filled out (78/103 patients, 76%	N/A	No statistically significant impact on nurse certainty of dietary plan and number of times needed to contact surgical teams	Contamination from nurses discussing study; lack of complete documentation on post-acute consultant ward round; low maintenance of intervention (75% proforma usage 6 months post-intervention); poor survey response rate
Alamri (2016)	Ward round checklist/proforma	Checklist implemented during inpatient surgical ward rounds	Most fields in proforma documented to adequate level (> 80% documentation) 2 years post-intervention	N/A	N/A	Timing bias, ‘snapshot’ vs longitudinal study; lack of exploration of freehand notes to identify reasons for proforma documentation deficiency
Alazzawi (2016)	Ward round proforma/checklist	Two versions (1. tickbox; 2. white spaces) of ward round checklist utilised, with a training session provided before implementation of each version. Each version was trialled for a period of 7 days, with a minimum 2-week gap between the trial of versions 1 and 2	Significant increases in documentation of diagnosis and management, objective assessments (excluding observations noted), and logistics	N/A	10 members of staff all preferred proforma vs standard care due to ease of reading and clarity of information	Effect on clinical assessment and patient care not measured; unblinded study; large amount of undocumented clinical activity
Banfield (2018)	Post-acute ward round proforma/checklist	Ward round checklist consisting of 10 different points, to be used as a ‘time out’ after each patient with clarification of these points from the whole surgical team	Improvement in documentation of VTE assessment, fluids, observations and investigations post-intervention; improved weekend documentation in all categories except length of stay	N/A	junior team members found that checklist improved understanding of diagnosis, management plan, and ward round effectiveness	Small sample size; reduced checklist access for outlying patients
Blucher (2014)	Ward safety proforma/checklist	Junior surgical staff formally educated on ward safety checklist, with implementation for 1 week during surgical ward rounds	Overall significant improvement in introduction phase components of checklist (31% vs 52%); overall significant improvement in time-out phase components (37% vs 45%); overall significant improvement in actions phase components (48% vs 56%)	N/A	N/A	Small sample size; no standardisation of time-out phase components in checklist; effect on clinical assessment and patient care not measured
Brown (2019)	Surgical communication check sheet/proforma	Ward round checklist comprising of 13 questions, including a mixture of yes/no questions and 10-point Likert scale questions (very poor —> excellent), which were employed during the trauma ward round	N/A	Reduction in percentage of patients with unanswered questions (21.8% vs 16.7%), reduction in number of patients unsure why a test was done (25.9% vs 12.7%), improvement in average understanding of management plan (64.7% to 83.3%)	N/A	Study unblinded; reduced sample size (survey compliance issues)
Byrnes (2009)	Ward round checklist/proforma	All SICU consultants and fellows were educated and encouraged to use the checklist during morning ward rounds	Verbal consideration of domains improved from 90.9% to 99.7% after intervention	N/A	N/A	Contamination bias in consideration phase (as checklist was optional for both groups); observer bias; no quantifiable data for some domains on checklist (e.g. tracheostomy protocol, need for central venous catheter, nutrition); questions about longitudinal checklist maintenance
Dhillon (2011)	Ward round checklist	Consultants were educated on the importance of ward round handovers and the use of the ward round checklist	Improvement in percentage adherence to the Good Surgical Practice Guidelines (55% vs 91%); significant improvement in documentation across all areas measured	N/A	N/A	Did not measure effect on morbidity and mortality; Hawthorne effect;
Dolan (2016)	Post-take ward round checklist/proforma	Information about ward round proforma disseminated via email; each admitted patient had a form placed in their admission documentation, and proforma was used for each post-take ward round	Improvement in documentation compliance across multiple categories	N/A	N/A	Small sample size; unblinded (Hawthorne effect)
Duxbury (2013)	Post-take ward round checklist/proforma	Proforma written on yellow paper which was placed in the patient’s notes	Improvements in documentation of multiple categories:	N/A	N/A	Small sample size; poor compliance to checklist during weekends, unblinded
Gilliland (2018)	Ward round template/checklist	Three Plan-Do-Study-Act (PDSA) cycles were performed to implement the new ward round template; changes were iteratively made to the ward round template based on results and further discussion after each cycle was implemented	Significant improvements in documentations of VTE risk assessment (14% to 92%) and antibiotic stewardship (0% to 100%), and use of the treatment escalation plan form (29% to 78%)	N/A	N/A	Small sample size; patient outcomes not measured, assumption of association between improved documentation and improved patient outcomes
Koumoullis (2020)	Surgical Tool for the Assessment of Rounds (STAR) checklist/proforma	STAR tool implemented during daily ward rounds	Checklist implementation improved STAR completion rate (47% to 70% to 88%);	N/A	Unsolicited enthusiastic staff comments about ward round improvement after STAR implementation	Hawthorne effect, weekend exclusion, seasonal patient variation
Krishnamohan (2019)	Ward round checklist	Checklist printed on yellow labels which were placed in patient clinical notes for documentation during the daily ward round	Overall documentation of six checklist parameters improved following implementation (26% to 79%); 3-month follow-up showed maintenance of 72% documentation compliance	N/A	N/A	Checklist reporting bias; quality of documentation not assessed; Hawthorne effect; relevance to patient outcomes not measured
Ng (2018)	Ward round sticker/checklist	Ward round stickers were placed in a patient’s notes, followed by review of sticker compliance	Significant improvement in checklist adherence across multiple tasks	N/A	N/A	Relevance to patient outcomes not measured; data for outlying patients not collected; Hawthorne effect
Pitcher (2016)	Ward round checklist	Ward round completed with a member of the team as a ‘prompter’ to encourage checklist criteria coverage	Significant improvement in the consideration of the majority of checklist criteria	N/A	N/A	Hawthorne effect (surgical team blind to nature of observations but were aware that observation was being conducted)
Pucher (2014)	Ward round checklist	Checklists implemented during daily wards, and adherence to critical care processes assessed in addition to technical and non-technical skills	Intervention group subjects using checklist had significantly fewer critical errors compared with controls (median(i.q.r.) 0(0–0) vs 60(40–73)%		Subjective ease of checklist use	Did not measure checklist use for medical staff outside of surgical trainees; single-centre study; did measure maintenance of checklist over time;
Read (2021)	Ward round checklist	Checklist implemented during the daily ward round	Overall percentage of checklist items endorsed increased significantly after intervention (64.8% to 70.0%)	N/A	N/A	Small sample size; patient could not compare standard vs checklist-implemented ward rounds as only subjected to one or the other; poor compliance with checklist completion from surgical teams; Hawthorne effect
Shaughnessy (2015)	Ward round checklist	Ward round checklist implemented during the daily ward round	87% of MDT respondents noticed improvement in bedside nurse attendance during ward round	N/A	97% of nurses agreed that verbal checklist summarising improved clarity and 90% felt it improved patient care	Patient understanding of ward round not measured; large variation in pre- vs post-checklist observation numbers—time limitation of post-audit; difficulty enforcing nurse checklist review compliance
Talia (2017)	Ward round checklist	Checklist implemented during the daily ward round	Significant improvement in documentation across multiple categories	N/A	N/A	Variation in pre- and post-checklist sample sizes; did not measure impact on patient outcomes
Tranter-Entwistle (2020)	Ward round checklist	Checklist implemented during the daily ward round	20/21 ward round quality indicators showed statistically significant improvement after checklist implementation	N/A	N/A	Lack of external checklist validation; single centre; single observer; no measure of impact on patient outcomes
Yorkgitis (2018)	Laboratory tests and chest X-ray imaging section on daily ICU checklist	Implementation of the checklist during the daily ICU ward round	No statistical reduction in laboratory tests or chest x-ray imaging ordered per day after checklist implementation	N/A	N/A	Checklist fatigue; checklist not reviewed daily;
Vukanic (2021)	Ward round proforma	Ward round proforma implemented during the daily ward round	After proforma introduction, average documentation criteria fulfilment percentage increased (0% to 86%); maintenance was 75% criteria fulfilment after 2 months	N/A	N/A	Small sample size; baseline data collected on single day

SMO, senior medical officer; FY, foundation year; SICU, surgical intensive care unit; ICU, intensive care unit; CT, computerised tomography; VTE, venous thromboembolism; DVT, deep vein thrombosis; PTWR, post-take ward round; MDT, multi-disciplinary team