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Hourly Rounding: Increasing Patient Satisfaction in the Eme
Transcript of Hourly Rounding: Increasing Patient Satisfaction in the Eme
Do emergency department (ED) patients 18-65 years of age experience increased patient satisfaction with the intervention of intentional hourly rounding compared to the current practice of non-intentional rounding?
Increasing Patient Satisfaction in the Emergency Department
Michele Baldwin, Lindsey Graham,
Robin Lasarsky, Natalie Wiens
P-emergency department patients age 18-65
I- intentional hourly rounding
C- non-intentional rounding
O- patient satisfaction scores
Why the ED?
"51% of inpatients come from the ED and judge their inpatient experience based on their ED experience."
"EDs generate 42% of hospital admissions nationally and can influence hospital choice and satisfaction ratings."
The ED experience can affect 'repurchase' decisions which impact the finances of the hospital.
(Baker, 2012, p. 69; Meade, 2010, p. 666; Welch, 2009)
EDs have lowest satisfaction ratings nationally compared to all other hospital departments
Average fall cost $11,042
Average decubitus cost $15,958
Reduced call light use can save 326 staffing hours
(Meade, 2007; Meade, 2010)
Review of the Literature
The patient experience in the emergency department: A systematic synthesis of qualitative research
Gordon et al., 2010
10 qualitative studies focusing on adult experience in the ED
Staff-patient interaction important factor
Caring behavior from nursing staff
Communication of information
Anticipating needs of patient
Hourly rounding can improve interaction between nurse and patient
The effects of emergency department staff rounding on patient safety and satisfaction
Meade et al., 2010
28 EDs, 8 weeks, 3 rounding protocols
Nurse and support staff participated
Hourly rounding with individualized patient care (IPC) was most effective
LWBS reduced 23.4%
AMA reduced by 22.6%
Falls reduced by 58.8%
Overall patient satisfaction increased by 3.1%
78% of staff members felt rounding was beneficial to
32 emergency departments
Nurses and support staff participated
Hourly rounding with scripting
LWBS reduced by 23.4%
AMA reduced by 22.6%
Falls reduced by 54.5%
Patient satisfaction scores increased 5 to 20 mean points
Hourly rounding in the emergency department: How to accelerate results
Wright et al., 2013
2 EDs, same metropolitan area
Nursing and support staff participated
Hourly rounding, education brochure and comfortable ambience
Patient satisfaction increased by 2.1%
Patient satisfaction with information communication increased by 8.9%
Patient perception of care increased
Patient satisfaction with nursing care in an urban and suburban emergency department
Resource/float staff not trained
Initial start up cost
Increased patient satisfaction
Increased staff satisfaction
Decreased fall rates
Decreased pressure sores
Improved pain management
Return on investment
Inconsistencies in hourly rounding
Lack of follow-up
Progress not measured
Tulsa Area EDs
66% reported medications were ‘always’ explained
71% ‘always’ received help when wanted.
72% felt pain was ‘always’ controlled/managed
80% reported nurses ‘always’ communicated well
HCAHPS Oklahoma Score Priority
Emergency Department Priority Index Nationwide
(Press Ganey, 2011)
Making the Change
Based on review of the literature, hourly rounding shows promising results in increasing patient satisfaction and safety, improving financial performance, and improving staff member satisfaction and retention in the ED.
Lewin’s Change Theory
Experiencing the change
3 Stages of Change
Awareness of the problem
Supported by HCAHPS and Press Ganey results
Experiencing the Change
Incorporating new Protocol
Hourly rounding as the required behavior
Staff members accept the new behavior
increased patient satisfaction scores
increased staff member satisfaction scores; retention
improved finances of organization
Lewin's Change Theory
Hourly rounding on patients performed by ED staff members with emphasis on 4 P's and scripting.
Leadership rounds on patients and staff to follow up on hourly rounding behaviors
Ensures staff members are rounding consistently and effectively
Assures staff members are rounding and holds staff members accountable
Supports practice changes and allows leadership to identify and coach to those not meeting the required behavior
‘Staff champions’ assist with leading the change of hourly rounding.
Ensures consistency on all shifts
Allows for continual educational support and reinforces the process and behavior
Ensures consistent behaviors on all shifts, positive reinforcement to staff members, and continual training and feedback
Staff champions act as role models and continually train staff members
(Kessler et al., 2012; Deitrick et al., 2011; Olrich et al., 2012; Baker 2012)
Educate and train staff members initially and continually.
Include with unit orientation, as an annual competency, and with unit meetings to ensure effectiveness and allows for enhancements
Formalized staff training and competency assessment are keys to success
It is imperative that all staff members are trained on rounding protocols for success and hospital-wide roll out
Supports the value and process of hourly rounding within the department
(Kessler et al., 2012; Baker 2012; Olrich et al., 2012; Petras et al., 2013)
(Baker, 2012; Kessler et al., 2012; Dewing & O’Meara, 2013)
Tools to Implement Hourly Rounding
Rounding Log Sheets
Hang in patient rooms
May be dry erase or paper
Badge Card for Staff Members
Highlights points of emphasis when interacting with patient
Serves as a reminder for hourly rounding
Serves as a reminder for staff members
Offers quick hit training
Flyers and Posters for Unit
Tool for unit manager, educator, and staff champion to use
Ensures staff members are knowledgeable of the hourly rounding process
Short Term Evaluation
Audits performed every shift
Ensures log sheets are completed
Ensures 4 P’s are being addressed
Log sheets reviewed
Short Term Evaluation (cont.)
Follow-up phone calls to discharged patients
Allows patient to voice perspective
Share feedback with staff
Staff members complete a self-assessment
Allows staff to share perspective
Long Term Evaluation
Unit meeting monthly
Accountability, feedback and learning
Hourly Rounding Report monthly
Long Term Evaluation (cont.)
Allows for feedback
Measures staff morale
Highlights successes and opportunities
Follow-up phone calls
Public Health promotion specialist
New Research Questions
Can hourly rounding be implemented on other units and yield increases in patient satisfaction?
What is the correlation between decreased patient complications and staff performance of hourly rounds?
What are the most effective ways to improve patients' perception of pain management?
Baker, Stephanie. (2012). Hourly rounding in the emergency department: how to accelerate results. Journal of
emergency nursing, 38(1), 69-72. doi: 10.1016/j.jen.2011.09.013
Deitrick, L., Baker, K., Paxton, H., Flores, M., Swavely, D. (2012). Hourly rounding: challenges with implementation of an evidence-based process. Journal of Nursing Care Quality 27(1): 13-9. doi: 10.1097/NCQ.0b013e318227d7dd
Gordon, J. B., Sheppard, L. A., & Anaf, S. (2010). The patient experience in the emergency department: A systematic
synthesis of qualitative research. International Emergency Nursing, 18, 80-88.
Kessler B, Claude-Gutehunst M, Donchez A, Dries R, & Megan S. (2012). The merry-go-round of patient rounding: assure
your patients get the brass ring. Medsurg Nursing, 21(4), 240-245.
Meade, C.M., Kennedy, J., & Kaplan, J. (2008). The effects of emergency department staff rounding on patient safety
and satisfaction. The Journal of Emergency Medicine, 38(5), 666-674. doi:10.1016/j.jemermed.2008.03.042
Meade, C. (2007). Round bounty. One-hour rounding positively influences patients and nursing staff members.
Marketing Health Services, 27(1), 23-27.
Dewing, J. & O’Meara, B. L. (2013). Introducing intentional rounding: a pilot project. Nursing Standard, 28(6), 37-44.
Olrich, T., Kalman, M., & Nigolian, C. (2012). Hourly rounding: a replication study. MEDSURG Nursing, 21(1), 23-6, 36
Petras, D., Dudjack, L., Bender, C. (2013). Piloting patient rounding as a quality improvement initiative. Nursing Management, 44(7), 19-23. doi: 10.1097/01.NUMA.0000431432.46631.85
Pham, J., Treuger, S., Hilton, J., Khare, R.., Smith, J., & Bernstein, S. (2011). Interventions to improve patient-centered
care during times of emergency department crowding. Academic emergency medicine, 18(12), 1289-94. doi: 10.1111/j
Welch, S. J. (2009). Twenty years of patient satisfaction research applied to the emergency department: A qualitative
review. American Journal of Medical Quality, 25(1), 64-72. doi: 10.1177/1062860609352536
Wright G, Causey S, Dienemann J, Guiton P, Coleman FS, & Nussbaum M. (2013). Patient satisfaction with nursing care in
an urban and suburban emergency department. Journal Nursing Administration, 43(10), 502-508. doi: 10.1097/NNA
Patients left without being seen (LWBS), patients leaving against medical advice (AMA), falls, and call light use had significant decreases.
Patient satisfaction scores increased focusing on overall care, pain management, and being informed about delays and plan of care.
78% of staff members felt rounding was beneficial. Staff members felt communication, teamwork, and time management were improved.
Return on investment (ROI). A hospital in Texas saw a ROI of $480,000.
Meade et al., 2010; Baker, 2012.
The process in which a nursing staff member enters a patient’s room every hour and addresses their needs
Pre-developed statements or questions that act as reminders for nurses to ensure that all that needs to be communicated is said
Hourly rounding effectively increased patient satisfaction
Patients perceived better quality of care
Increased staff satisfaction
Decreased falls, AMA, LWBS