Improve Clinical Outcomes with Hourly RoundingSM

Hourly RoundingSM on patients delivers quality clinical outcomes and makes the job easier.


What if your nurses could save 82 hours each week1 responding to call lights and deliver better clinical outcomes for patients? Hourly RoundingSM is a new best practice that reduces patient falls and skin breakdowns while improving patient satisfaction. The rounding protocol also drives more nursing care to the bedside, so nurses can be proactive instead of reactive with respect to workflow.

As reported in the September 2006 American Journal of Nursing,2 Studer Group's research subsidiary, the Alliance for Health Care Research (AHCR), completed a rigorous study that analyzed the impact of Hourly RoundingSM on patients in 27 nursing units (telemetry, surgical and medical-surgical) from 14 hospitals nationwide using a specific protocol.

Why Do Call Lights Ring?

When baseline data was collected, researchers learned that the top reasons patients used the call light were: bathroom/bedpan assistance (15%); IV /pump alarm (15%); pain medication (10%); needed a nurse or CNA (9%); and position assistance (4%), as well as accidental hits of the call light (13%) and miscellaneous reasons (13%).

By rounding hourly on patients, the units reduced requests:

  • bathroom by 40%
  • pain by 35%
  • positioning by 29%
  • IV/pump alarms by 40%
  • miscellaneous by 39%

How They Did It: The 8 Rounding Behaviors

For six weeks, nurses and CNAs were instructed to round hourly on patients during the day and every two hours at night using key words that addressed the eight rounding behaviors:

  1. Use opening key words to reduce anxiety.
  2. Perform scheduled tasks.
  3. Address the 3 P's: pain, potty, and position.
  4. Assess additional comfort needs.
  5. Conduct an environmental assessment.
  6. Prior to leaving, ask, "Is there anything else I can do for you? I have time."
  7. Tell each patient when you will be back.
  8. Document the round on the patient chart.
Hourly RoundingSM Get Results
Call Lights Down 37.8%
Patient Satisfaction Up 12 mean points
Patient Falls Down 50%
Skin Breakdown Down 14%

*These results are based on an average of all participating units.

If you consider that falls cost a hospital an average of $11,402 per fall3 and a single hospital-acquired decubitus (pressure ulcer) costs an average of $15,958,4 imagine the savings you could create in your organization by implementing Hourly RoundingSM.

One Year Later

Did Hourly RoundingSM become hardwired at participating hospitals? A year after the initial study was complete, AHCR followed up to find out. The goals: to see if units were still rounding; if other units in the hospital had adopted rounding; and how patient satisfaction scores and fall rates had changed since the beginning of the study.

Not only did original study participants sustain their gains in quality and patient satisfaction, but 92% had expanded the rounding to other units. Nearly 86% of the original units in the study were still rounding.

Thanks to These Participants in AHCR’s Call Light Study

Ball Memorial Hospital, Muncie, IN
Baylor University Medical Center, Dallas, TX
Baylor Institute for Rehabilitation, Dallas, TX
Bethesda North Hospital, Cincinnati, OH
Brandon Regional Hospital, Brandon, FL
Carolinas Medical Center, Charlotte, NC
CMC-University Hospital, Charlotte, NC
Cooper University Hospital, Camden, NJ
Euclid Hospital, Cleveland, OH
Delnor-Community Hospital, Geneva, IL
Falls Memorial Hospital, International Falls, MN

Jewish Hospital, Louisville, KY
Largo Medical Center, Largo, FL
New Hanover Regional Medical Center, Wilmington, NC
Northeastern Hospital, Philadelphia, PA
Palmetto Health Baptist Easley Hospital, Easley, SC
Sacred Heart Hospital, Eau Claire, WI
Sharp Memorial Hospital, San Diego, CA
South Pointe Hospital, Cleveland, OH
St. Elizabeth's-Caritas Health System, Boston, MA
Temple University Hospital, Philadelphia, PA
The Valley Hospital and Health System, Ridgewood, NJ

 

1 In a study by the Alliance for Health Care Research (American Journal of Nursing, September 2006), nurses who rounded hourly on patients reduced call lights by 4,901 in a four week period. If an average response to a call light is estimated to take 4 minutes, nurses saved 326 hours per month or 81.5 hours each week.
2 “Effects of Nursing Rounds on Patients’ Call Light Use, Satisfaction, and Safety,” AJN September 2006 Vol. 106, No. 9
3 “Payments for “Adverse Events,” AHRQ 2005
4 National Center for Injury Prevention, 2004; Rizzo, 1998

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