Hourly Rounding

Hourly Rounding in Hospitals

Abstract

Scheduled patient rounds, or “rounding,” give nurses and other clinical staff a concise and updated awareness of their patients' needs. This awareness can help staff anticipate patient requests so effectively that patients may only need to use their call lights in emergencies.

Table of Contents

INTRODUCTION2

LITERATURE REVIEW2

METHODOLOGY3

RESULTS6

DISCUSSION7

CONCLUSION10

REFERENCES12

Introduction

One of the very few studies investigating the subject of rounding appeared in the September 2006 issue of the American Journal of Nursing. This controlled clinical trial, conducted by Christine Meade, PhD, Amy Bursell, PhD, and Lyn Ketelsen, MBA, RN, looked at changes in fall rates, call bell use, and patient satisfaction in 14 hospitals (27 nursing units) that implemented scheduled nursing rounds over a four week period using the protocol. Their findings were impressive. One-hour rounding was clearly the best practice, as it reduced call light use by 37%, at 4,901 fewer call lights. Requests for bathroom assistance went down by 40%, pain medication calls went down 35%, requests for positioning help decreased by 29%, and intravenous pump alarms decreased by 40% over the study period. Patient satisfaction improved by 12 percentage points, with 92% of patients reporting they were satisfied with their care overall.

Literature Review

A review of the literature found that call light use decreased 38-62%, patient falls 50-90% and patient satisfaction increased by 8.9-10.7 points after hourly rounding was implemented. In addition, an efficiency study found that a nurse is called to each patient's room an average of 12- 15 times a day for non-urgent matters with each response taking approximately four minutes of a nurse's time. Theoretically, hourly rounding can save 166 hours a month in staff time.

Of particular note, hourly rounding saved nursing staff at the 14 hospitals an average of 326 hours each week - time that could then be directed to other nursing tasks and direct patient care. Not surprisingly, nurses reported they had fewer interruptions and more time to complete other tasks (e.g., charting, and patient education). The rate of falls also decreased impressively in the 14 hospitals surveyed, with 50% fewer falls occurring over the course of the study, corresponding to an all-hospitals cost savings of $143,546 during this onemonth period. These improvements were sustained over time, according to a follow-up survey by Dr. Meade and her colleagues one year later (Meade et al, 2006). The rate of falls continued to drop slightly to an overall decrease of 60%, patient satisfaction ratings remained high, and thirteen of the hospitals had expanded scheduled rounds to other units or the entire hospital (C. Meade, personal communication, February 16, 2008).

Methodology

To test the hypotheses, we used a quasiexperimental design with nonequivalent groups.30 There was nonrandom assignment of hospital units to experimental and control groups; in this case, chief nursing officers and nurse managers at the participating hospitals assisted in the assignment of each unit to one of the three study groups: control, “one-hour rounding,” and “two-hour rounding.” (One-hour rounding was defined as rounds being performed once an hour between 6 am and 10 pm and once every two ...