Improving patient care and satisfaction is an ongoing development in all healthcare organizations. In the United States, falls in the hospital setting range from 2.3 to 7 falls for every 1,000 patient care days (Ford, 2012). The majority of these falls are associated with the elimination needs of the patient. The ability of the nursing staff to assist with these needs in a timely manner, not only affect the risk for fall, but also the institution’s patient satisfaction scores. Patients that experience falls while in the hospital are at risk for injuries ranging from fractures to death. For this reason, Joint Commission has made fall prevention one of their priorities with the National Patient Safety Goals and requires accredited facilities to use methods which reduce the risk of falls (Ford, 2102). In contrast to patient falls negatively effecting patient satisfaction, cost for patient care increases. With today’s continuous need to thrive in a very competitive world, increased cost and decreased patient satisfaction can affect an institution’s ability to succeed due to reimbursement and respect in the community. For this reason, many groups have studied ways to increase patient satisfaction. One group known as the Studer Group, developed a protocol for one hour rounding in an effort to organize work, meet patient needs, and improve patient safety (Ford, 2012). Since this development, many facilities have implemented this protocol and researchers have studied its effects.
Review of Literature
Berg, Sailors, Reimer, and O’Brien (2011) investigated whether one hour rounding would increase patient satisfaction and decreased call light usage. The setting for the study was a 28 bed medical surgical unit in an acute care facility. Participants were chosen randomly on a voluntary basis. Patient rounds were divided between nurse and patient care assistant in order to ensure one hour rounding. While rounding, staff was instructed to address the three P’s, potty, position, and pain with each patient. A documentation sheet was developed prior to implementing one hour rounding, and used to record call light usage. When a patient called for assistance, the unit secretary would document the call and the patient’s need. “Using a longitudinal research design, data was collected prior to, and after the implementation of hourly rounding” (Berg et al., 2011). Data was obtained using randomly selected rounding documentation records for 35 days prior to implementing one hour rounding (Berg et al., 2011). Three months post-implementation, an additional thirty five randomly selected rounding documentation records were used to determine the effect hourly rounding had on call-light usage (Berg et al., 2011). Descriptive statistics were used to determine the range for call light usage. The range decreased from 4-21.5 to 1-19 calls per day. Therefore, an average decrease of 3.7 calls per patient per day was observed. Press Ganey evaluations were used to track patient satisfaction. After implementing one hour rounding, patient satisfaction scores improved in the areas response time and nurses’ attitude toward requests (Berg et al., 2011).
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Kessler, Claude-Gutekunst, Donchez, Dries, and Snyder (2012) identified areas for improvement on a new thirty eight bed unit at their hospital with patient and employee satisfaction scores, patient fall rates, and nosocomial pressure ulcers. In an attempt to make improvements, a study was conducted to determine “whether the implementation of hourly patient rounding would have a positive impact on patient and staff satisfaction scores, and the nurse-sensitive clinical outcome indicators of falls and nosocomial pressure ulcers” (Kessler et al., 2012). A protocol implemented that would include hourly rounding and documenting on rounding logs that were placed on the wall directly across the room from the patient. “The protocol included attention to pain, position, and personal needs (the three Ps); assurance that the call light, television remote control, tissues, full water cup, and trash can are within reach; and an environmental safety check” (Kessler et al., 2012). Also, “is there anything else I do for you before I leave? I have the time. We’ll be back in an hour to check on you” (Kessler et al., 2012), was a script given to employees to use prior to leaving the room. This would reassure the patient they would be returning. The strength of this study was the length of time the hourly rounding was studied. Using quantitative metrics, outcomes from Press Ganey scores, HealthStream employee satisfaction scores, hospital fall rates, and hospital RN vacancy rates were compared for six years. Patient satisfaction scores from Press Ganey provided evidence of sustained improvement during the six years studied. Employee satisfaction scores also improved over these six years and exceeded the HealthStream national database performance mean. RN vacancy and patient fall rates demonstrated a continuous decrease after initiating one hour rounding (Kessler, et al., 2012).
In an effort to increase patient satisfaction, Beverly M. Ford (2010) conducted a study to evaluate the benefits of hourly rounding. Two random samples of patients were tracked for three weeks. One group had one hour rounding implemented, while the other group served as a control. All patient needs were documented when patient used the call light. Two weeks prior to implementation, a call light log was maintained. After three weeks of rounding on the sample of 51 patients, qualitative data was collected from the rounding sheets and call log. Also, phone calls were placed to discharged patients from both groups to ask about their satisfaction with the facility. Call light logs revealed a 52% decline in calls after implementing one hour rounding. Patient needs were analyzed to show the reason for calls prior to and after implementing one hour rounding. There was a decline in all areas observed which included pain, personal needs, positioning, placement, error, and other. Calls placed to the discharged patients that were recipients of the one hour rounding, revealed a greater satisfaction in overall care compared to the patients that were not included in the hourly rounding. Beverly Ford concluded that “consistent hourly rounding is a key for improving safety and quality of care; it results in fewer call light interruptions, allowing nurses to organize their time better and reduce stress” (Ford, 2012).
A medical surgical unit in a northeast hospital wanted to decrease their fall rates and increase patient satisfaction scores. They studied call light use retrieved from a computerized system from a two week period which revealed 2,237 – 4,223 individual uses. Fifty-seven of these calls revealed a need for pain measures, toileting needs, and personal or comfort needs. Also their patient satisfaction scores revealed only 75 percent of the patients were willing to recommend their facility. For all these reasons, the authors of this article wanted to study the effects of one hour rounding on patient satisfaction, call light use, and patient fall rates. A quasi-experimental study was performed using two medical-surgical units. One unit was used to study and the other was used as a control. All patients discharged within the next year from both units were used for the study. This consisted of 4,418 discharged patients. Data was collected from fall rates, call light usage, and patient satisfaction prior to and after implementing one hour rounding from both units. Fall rates decreased from 3.37/1,000 patient days to 2.6/1,000 patient days on the unit that implementing the hourly rounds. There was also a twenty three percent significant reduction in falls on that unit. Determining the significance with a decrease in call light usage was difficult to determine due to a delirious patient that was hospitalized on the unit for two weeks. The results were still believed to be promising and according to Olrich, Kalman, and Nigolian (2012) “if nursing leaders want to implement hourly rounding protocols successfully, attention should be focused on enlisting staff champions to ensure rounding behaviors are performed consistently on all shifts” (Olrich et al., 2012).
According to Meade, Bursell, and Ketelsen (2006), patient’s satisfaction with nursing is dependent upon their response time to the patient’s needs. They conducted a study to prove that regular rounding would affect call light use, patient satisfaction, and improve patient safety specifically with patient falls. They used a quasi-experimental design with twenty-two hospitals and forty-six units. Twelve of those units were used for a control. Each hospital was allowed to use either one hour or two hour rounding but had to agree to keep precise records. Eight of the twenty-two hospitals were excluded in the end due to poor data collection. Data was collected from the remaining hospitals for a period of six weeks. In the area of patient satisfaction, the data collected was compared to a four week period prior to implementation of regular rounding. The results supported an increase of 79.9 to 91.9 on the units that implemented the one hour rounding. On the units that used the two hour protocol, the mean score increased from 70.4 to 82.1. While both groups showed an increase in patient satisfaction, the units using the one hour rounding received the higher scores. With patient safety the fall rates were examined comparing the experimental units to the control units. The data collected showed a significant decrease in the amount of falls only on the units that had implemented the one hour rounding. Reviewing the call light use from the units using regular rounding, there was a significant decrease in call light use. Call lights answered decreased from a mean of 4,381.7 to a mean of 3,596.3. The reasons for the calls in both the control and the experimental group did not change. The limitation to the design was that there was no way to ensure equivalent groups in the study. Even with this limitation, the findings “provide evidence that improved patient-care management and patient satisfaction and safety are achievable with interventions that nurses can initiate and carry out” (Meade et al., 2006).
Summary of Research Studies Cited in the “Review of Literature”
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B
C
D
E
Authors and Date
Berg et al., 2011
Kessler et al., 2012
Ford, 2012
Olrich et al., 2012
Meade et al., 2006
Sample Size
28 Bed Unit
30 Bed Unit
51 Patients
4,418 Patients
46 Units
Population
Medical Surgical Unit in Acute Care Hospital
Medical-Surgical Unit in Acute Care Hospital
Unit in Acute Care Hospital
Two Medical Surgical units in a 506 Bed Acute Care Hospital
22 Hospitals
Variables Studies
The effects of hourly rounding on patient satisfaction and call light usage
The effects of hourly rounding on patient and staff satisfaction, falls, and nosocomial pressure ulcers
The effects of hourly rounding on patient satisfaction
The effects of hourly rounding on patient satisfaction and fall rates
The effects of hourly rounding on call light use, patient satisfaction, patient safety (falls)
Research Recommendations/ Nursing Implications
Recommendations for improving patient satisfaction, decreasing falls, and decreasing call light usage were discussed in the literature. All of the studies revealed a connection between one hour rounding and improving patient satisfaction and decreasing call light usage. Not all studies addressed fall rates, but of those that did, fall rates were decreased with the one hour rounding. All studies had their limitations and all authors recommended continuing studies in this area.
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Summary
Research studies on the effects of one hour rounding are ongoing today. As one author wrote “hourly rounding is about engaging the patients – going in and finding out their needs and accomplishing tasks” (Ford, 2012). Making rounds have always been a part of nursing, but unfortunately not always carried out. With the need to excel in excellent patient care, nurses need to continue to look for evidence based practices that are beneficial. The writer plans to implement one hour rounding in a local facility in hope of determining first hand if one hour rounding versus two hour rounding can improve patient care.
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