Improving care for patients in the outlying wards: Lessons from patients’ care experience
Authors:   MBChB, NHS Lothian Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom., Sobolewska Victoria , Duff Hamish ,   MBChB, NHS Lothian Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom., Craighead Felicity ,   MBChB, NHS Lothian Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom., Macpherson Iain ,   MBChB, Gut Group, University of Dundee, Dundee, UK. ORCID ID https://orcid.org/0000-0003-0443-2073 Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom., Veiraiah Aravindan ,   MBBS, NHS Lothian Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom., Dummer Simon ,   MBChB, NHS Lothian Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom., A Lockman Khalida ,   MB Bch MD FRCP, NHS Lothian Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom.
Published: June 2022

Importance: Overcrowding in hospitals and lack of capacity in general medical wards can result in a medical patient being transferred to other specialty wards often referred as ‘outlying’ or ‘boarding’ wards. Objectives: We explored the experiences of our outlying patients to identify local factors that affect their care experience and inform interventions that could improve their care deliveries and outcomes. Design, setting, and participants: Qualitative interviews using semi-structured questions were conducted in 21 medical patients from a mixture of specialty wards in a large tertiary NHS hospital. Main Outcomes and Measures: Perceptions of the factors contributing to the experience of being a patient on a boarding ward, and potential solutions. Results: Almost all participants reported experiences of good care in an outlying ward. Positive comments highlighted good nursing care, restful environment and a strong focus on patient-centred care. However, none of the participants could identify the team or consultant responsible for their care and this was linked to multiple doctors being involved in the patient’s care. Participants also perceived that the frequency of review was reduced and occurred much later in the day than that experienced in the medical ward. Most felt indifferent about the care ownership, timing and frequency of review but in some cases, this led to confusion and the perception of poor progress. Further, participants felt that they had to actively seek information relating to clinical progress. Negative experience of discharge planning was also reported. The associated themes included conflicting information and delays in social care provision. This led to anxiety, frustration and the perception of being a barrier to patient flow. Conclusions and Relevance: Patient experience of the outlying ward is positive, and this can provide a foundation for improvement. Our findings suggest that better care processes and improved communication are needed to promote equity and quality of care. However, this should be complemented with efforts to overcome wider challenges that affect the entire continuum of flow within the healthcare system.