Reduce Falls, Overtime and Lost Charges with Hourly Rounding
In the September 2006 issue of American Journal of Nursing, Studer Group's Alliance for Health Care Strategy published its national study of hourly rounding on patients. The results: fewer call lights, less falls, and higher patient satisfaction.
Since then, hundreds of hospitals have adopted hourly rounding on inpatients and patients in the emergency department with impressive benefits to the bottom line, too. Covenant Health System, a six-hospital system with 6,000 employees serving west Texas and Eastern New Mexico initiated hourly rounding and individualized patient care in August 2006. Six months later, leaders credit these tools with saving $132,000 in patient falls10, capturing lost charges of $81,600 per year and overtime savings of 220 hours or $1,76411.
How does hourly rounding link to capturing lost charges? "The reduction in call lights was so dramatic that it created a calmer work environment for nurses," explains Covenant's Studer Group coach." As a result, nurses had more time to be proactive about capturing charges, documenting, and coding.
Karen Baggerly, chief nursing officer for Covenant Health System in Lubbock, Texas has seen the results of hourly rounding first hand. "We chose a handful of units to pilot hourly rounding and the results have been remarkable," Baggerly explains. "What I enjoy most is hearing from the nurse leaders and nurses themselves about the real wins: reduced call lights, fewer falls and reduced incidences of pressure ulcers. This tactic supports our desire to do the right thing for all the right reasons." What do nurses at Covenant like best about hourly rounding? "It creates an environment where our nurses have more time to do what they came here to do: provide the very best care to our patients," she adds.
How to Hardwire Results with Hourly Rounding |
Sacred Heart Hospital in Pensacola, FL started training nurses how to round hourly on patients in November 2006. Three months later in February 2007, with 11 nursing units on board, patient satisfaction with overall nursing has already soared 40 percentile points (Press-Ganey). Overall patient satisfaction has increased 45 percentile points since baseline in November.
"I think we're getting consistently excellent results because we've hardwired accountability," explains Sacred Heart administrative director and Studer Group coach Joana Adams. "We have focused on ways to reduce individual variance from the start... like using an hourly dashboard report and creating an hourly rounding competency checklist."
Sacred Heart's other secret weapon: an hourly rounding meeting led by the CNO or director to drive accountability. The meeting includes leaders from all units currently participating in hourly rounding as well as those coming on soon.
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The meeting goals: To understand challenges, transfer learning and best practices and hold leaders accountable for getting results.
At the weekly meeting, the leader asks:
- What is working well? What are the barriers? Nurses share patient letters, stories, and staff feedback.
- What are the tough questions staff ask?
- What actions will nurses take to improve their hourly rounding results? What have they learned at the meeting that they want to implement?
In addition, each leader reports his or her unit's patient satisfaction results and reviews the percentage of "competency checklists" completed for the week. Finally, leaders trade completed call light and rounding logs and share feedback based on their review. (See sidebar to download samples of these tools.)
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10 Estimated at six fewer falls since baseline measurement before implementing hourly rounding at $22,000 cost per fall (Nurse Week Magazine, Jan. 29, 2007).
11 Overtime savings based on hourly rate of $8 for three nurses multiplied by 1.5 hours less overtime per week for 49 weeks.
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