The Sterile Cockpit: A Passenger's View. Patient's Perceptions of Safety, Quality and Delivery in the Surgical Ward Round

Background The ward round is the main communication channel between doctors and hospitalised patients; however, it is often poorly received by patients. Patient perceptions are rarely considered when implementing interventions in inpatient environments. This study therefore aimed to thematically assess patients' perceptions of a ‘Standard care’ ward round versus a ‘Sterile Cockpit’ ward round. Methods There were 71 Standard Care and 70 ‘Sterile Cockpit’ ward rounds audio‐visually recorded. The ‘Sterile Cockpit’ group received a modified ward structure consisting of a protected zone where aviation‐safety rules (allocation of team roles, no interruptions, one person speaking at a time, repeating of plan) were applied. Following the encounter, patients completed a survey on their perceptions of the ward round. Statistical analysis using Generalised Estimating Equations was conducted for quantitative outcomes, and qualitative outcomes were analysed using the six‐stage process for thematic analysis. Results Of the 141 recorded ward round encounters (51% male, mean age 61.6 [SD: 15.4]), there were 130/141 (92%) surveys completed. Overall, patients in the ‘Sterile Cockpit’ group had significantly higher satisfaction than the Standard Care group, even when adjusting for the patients' sex, age, emergency/elective admission, and clustering on the patient (IRR: 1.07, 95% CI: 1.00, 1.14, p = 0.036). Thematic analysis determined that patients' perceptions of surgical ward rounds revolved around three key themes (Structure, Understanding and Engagement) and two subthemes (Communication Quality and Time). Conclusion Implementing the Sterile Cockpit ward round model was associated with an improved patient experience by enhancing understanding, engagement and perception of team dynamics, without increasing ward round duration. These findings suggest the Sterile Cockpit is a pragmatic solution to improving patient care and optimising the short amount of time that is available for ward rounds.