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Hourly Rounding: Increasing Patient Satisfaction in the Eme

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Natalie Wiens

on 24 April 2014

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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?

Hourly Rounding:
Increasing Patient Satisfaction in the Emergency Department

PICO Question
Michele Baldwin, Lindsey Graham,
Robin Lasarsky, Natalie Wiens

PICO Defined
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)
Statistics
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
STAFF

Baker, 2012
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
Barriers

Staff resistance

Resource/float staff not trained

Initial start up cost

Benefits

Increased patient satisfaction

Increased staff satisfaction

Decreased fall rates

Decreased pressure sores

Improved pain management

Increased efficiency

Return on investment

Local Practices
Inconsistencies in hourly rounding
Lack of follow-up
Progress not measured

Tulsa Area EDs
Local Results
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

(www.medicare.gov, 2013)
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
Unfreezing
Experiencing the change
Refreezing

3 Stages of Change
Unfreezing
Awareness of the problem

Supported by HCAHPS and Press Ganey results
Experiencing the Change
Incorporating new Protocol

Hourly rounding as the required behavior
Refreezing
Staff members accept the new behavior
Measured by
increased patient satisfaction scores
increased staff member satisfaction scores; retention
improved finances of organization
Lewin's Change Theory
Recommendations
Protocol #1
Hourly rounding on patients performed by ED staff members with emphasis on 4 P's and scripting.

Protocol #2
Leadership rounds on patients and staff to follow up on hourly rounding behaviors

Rationale
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


Protocol #3
‘Staff champions’ assist with leading the change of hourly rounding.

Rationale
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)
Protocol #4
Educate and train staff members initially and continually.

Rationale
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
Competency Checklist
Tool for unit manager, educator, and staff champion to use

Ensures staff members are knowledgeable of the hourly rounding process

Evaluating Effectiveness
Short Term Evaluation
Audits performed every shift
Ensures log sheets are completed
Ensures 4 P’s are being addressed

Log sheets reviewed
Highlights trends

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
Identify trends

Long Term Evaluation
Unit meeting monthly
Accountability, feedback and learning

Hourly Rounding Report monthly
Highlights ROI

Long Term Evaluation (cont.)
Performance evaluations
Allows for feedback
Measures staff morale

HCAHPS scores
Highlights ROI
Highlights successes and opportunities

Further Study
Additional Approaches
Follow-up phone calls

Ambience/environment

Flyers handouts

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?

References
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.
doi: 10.1016/j.ienj.2009.05.004

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.

References
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
1553-2712.2011.01224.x

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
0b013e3182a3e821

Yoder-Wise, 2011

Questions?
Rationale
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.
Hourly Rounding
Scripting
Terms Defined
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
Summary
Hourly rounding effectively increased patient satisfaction

Patients perceived better quality of care

Increased staff satisfaction

Decreased falls, AMA, LWBS
Full transcript