Hourly Rounding Dims Call Lights

In the middle of "3P” rounding are three oncology staff nurses(from left to right) Bette Williams, RN, BSN, Dawn Cichewicz, RN, BSN, and Kristen Garofalo, RN, at Valley Hospital and Health System, Ridgewood, N.J. Photo courtesy of Valley Hospital and Health System.

Nationwide study sparks protocol to improve nurse efficiency and patient satisfaction.

Nurses involved in an hourly rounding protocol are finding their shifts less stressful, their time more productive, and patient safety and satisfaction scores hitting all-time highs.

The new strategy for rounding comes in the wake of research results from 27 nursing units in 14 hospitals across the country that show how consistently checking on patient needs reduces monthly call-light use by 38%, patient falls by 50%, and skin breakdowns by 14%, while satisfaction scores move upward.

“The response has been amazing,” says Christine Meade, chief researcher and health care coach with the Studer Group’s Alliance for Healthcare Research, Gulf Breeze, Fla. “Nurses know rounding works ... but nobody’s ever done a study to prove it.”

Meade says she gets approximately 10 e-mails a day about the research results and is part of a team of coaches who present the rounding protocol to hospital units, including several in Pennsylvania and New Jersey. An interactive training video toolkit (available from the Studer Group for $1,495) shows study data and demonstrates how specific behaviors and actions by nurses on hourly rounds can improve satisfaction rates and give nurses more free time.

Of all the indicators of success, “satisfaction jumps through the roof,” says Meade. The savings potential from rounding also attracts interest, because patient falls cost hospitals an average $11,000 apiece and incidents of decubitus ulcers cost $14,000 each, not including possible lawsuits.

Proof positive

At Valley Hospital and Health System in Ridgewood, N.J., about 60 nurses and patient care associates in an oncology unit took part in the Studer Group study after being trained in the behaviors they had to adopt. In the process, they found 75 reasons why patients use call lights.

Most often, patients wanted relief from pain or had personal needs, such as going to the bathroom or repositioning themselves on their beds. In a four-week period of hourly rounding, call-light use was reduced 62.5%, patient falls declined 54%, and patient satisfaction scores jumped, says unit oncology manager Patrice Wilson, RN, MSN, MA, from Valley Hospital.

“What’s so splendid about hourly rounding is its simplicity,” says Wilson. “It’s really getting back to basics.”

Nurses were required to use a specific script when visiting patients, and they wrote their names and portable phone numbers on white boards kept in patient rooms. Nurses also adhered to the Studer Group’s explicit “three Ps” rule — pain, potty, positioning — to make patients as comfortable as possible.

Mary Jo Assi, RN, MS, APNC, director of advanced practice nursing, says the positive results of rounding went beyond expectations and was recognized almost immediately by the hospital’s leadership council as a strategy to be implemented throughout the 451-bed health system.

“Consistent hourly rounding is a key concept for improving patient safety and quality care,” says Assi, adding that with fewer call-light interruptions, nurses can better organize their time and reduce stress. In addition, patient satisfaction scores recently reached the 90th percentile mark, and the goal is to go even higher.

“It’s a win-win situation on a very large scale,” says Assi. “Patients are less anxious because they know someone will be there to take care of them, and nurses are less harried and more capable of meeting patients’ needs.”

Timely approach to care

Lyn Ketelsen, RN, MBA, is a Studer Group coach and coauthor of the hourly rounding study who originated the research project after visiting numerous hospitals that were struggling to raise patient satisfaction rates. “One issue was responding to call lights and meeting patient needs in a timely manner,” says Ketelsen. “I did some observations, and it became clear that practicing in a reactive manner wasn’t serving [nurses] well.”

The researchers set up specific “scripts” and tactics for hourly rounding to ensure consistency and continuity of patient care that would lead to the best outcomes and satisfaction measures. Nurses were asked to follow 12 directives, the final one telling patients a nurse would return within an hour — or sometimes two hours during the late-night shifts.

“One of the biggest motivations for me was related to the efficiencies this was going to create for the nursing staff,” says Ketelsen. “In a finite way, rounding gives some time back to nurses, and they’re not as tired at the end of their shift.”

Ketelsen says she experimented with hourly rounding while coaching at hospitals for nearly a year before helping to launch the formal study that has resulted in the inpatient protocol. At one hospital, she had nurses wear pedometers and found they walked 5.2 miles per shift prior to implementing hourly rounding and 4.3 miles per shift with the rounding in place.

“They were shaving 20% off the steps they were taking to meet patient needs by being more proactive — that’s pure time given back to the staff.”

Eyes on the ED

Ketelsen says it was once standard practice to round hourly, but nurses often just peeked in the door and moved on unless a call light was pushed, signaling a real urgency. “The new rounding is more about engaging the patients — going in and finding out their needs and accomplishing tasks. It’s more comprehensive and more effective.”

The next test for patient rounding is in the emergency department setting. A research study is under way at Medical Center of Plano in Texas and in 30 other hospitals to determine the best approach for nurses in the busy, fluid ED environment, says Ketelsen.

She adds, “My hope would be that this research begins to establish a standard of practice for nurses that reinforces good, basic, solid nursing practice; gives time back to the staff; and increases the safety and quality of care.”

John Leighty is a freelance writer for Nursing Spectrum. To comment on this story, e-mail jspillane@nursingspectrum.com.

Correction:

NurseWeek inadvertently omitted information in the story, Let There Be Less Light by John Leighty, December 04, 2006 (this may be called something different in each region). The article was based on the study, Effects Of Nursing Rounds On Patients’ Call Light Use, Satisfaction, And Safety, originally published in the September 2006 issue of the American Journal of Nursing. The authors are Christine M. Meade, PhD, Amy L. Bursell, PhD, and Lyn Ketelsen, MBA, RN. We regret the omission.