Table of Contents
Summary
The hospital experience can be overwhelming for patients who have to deal with numerous concerns including their treatment, their hospital expenses, and other worries which are often exacerbated by hospital personnel going in and out of their rooms. Health managers have noted the importance of hourly rounding as a means of improving the patient experience, mostly in ensuring timely treatment as well as preventing patient injuries and reducing call light frequency. This paper set out to establish if hourly rounding does improve the patient’s experience. It covered five studies for this analysis and discussion in order to develop a comprehensive answer to the question. Based on the five studies reviewed, hourly rounding generally improves the patient’s experience, mostly in terms of reducing the frequency of nurse call lights, preventing patient injuries, and in ensuring that their basic needs are provided. There are however some methodological gaps in the studies which imply the need for improvements in future studies, mostly in terms of sample population covered and the type of study conducted.
Does hourly rounding improve the patient’s experience?
Introduction
Hourly rounding has been integrated into the nursing and clinical practice as a means of improving patient satisfaction and nurse/clinician efficiency. Health managers believe that when nurses do hourly rounds they are likely to be better providers of patient care and patients are likely to be more satisfied with the care they are receiving from their nurses. This paper will discuss the thesis that hourly rounding can improve the patient’s experience. Five peer-reviewed journals will be evaluated for this paper, their data assessed and their results discussed. A conclusion will be drawn based on the results from these five peer-reviewed studies.
Body
Being hospitalized is always a stressful experience for patients and their families. Aside from having to deal with their illness and being subjected to medical tests, they also have to deal with the numerous health professionals – doctors, nurses, pharmacists, medical technologists, and other health personnel – who would be walking in and out of their hospital rooms. Due to their illness and often vulnerable conditions, they have to deal with the indignities of requesting assistance for repositioning, for eating, for going to the bathroom, for brushing, for bathing, and for other related activities. Due to their unfamiliarity with how hospital activities are carried out and how their needs can be met, patients usually access the one thing at their easy disposal – the nurse call button. The patient’s expectations on how the nurse call button can work for them are often based on the reason they are using such button. Where their needs are urgent, an immediate response to the call button is expected, but for questions about a procedure they are about to undergo, a delayed response to the call button is acceptable to them. Hourly rounding relates to an intentional check of patients at regular intervals and has been considered a major tool in order to address patient’s basic needs and to improve the patient’s safety and general experience in the hospital setting.
Numerous reports indicate that purposeful rounding by nurses can improve patient satisfaction (Blakley, Kroth, & Gregson, 2011). In the systematic review by Mitchell, Lavenberg, Trotta and Umscheid (2014), the authors set out synthesize evidence on how hourly rounding can impact on patient satisfaction. They were able to review 16 published articles on hourly rounding and their review indicated that the results were not consistently measured but there is moderate strength evidence which indicates that hourly rounding programs can improve patient’s satisfaction and their perception of the nurses’ responsiveness to their needs (Mitchell, et al., 2014). There is also moderate strength evidence which indicates how hourly rounding is able to reduce patient falls and patient’s tendencies towards call light use (Mitchell, et al., 2014). This review however had methodological biases which made the results less generalizable to the larger setting. The studies were also not randomized. There are limitations on the causal relationship between hourly rounds and study outcomes. In general, the study also presented low scores in terms of responsiveness from nurses when applied as a gauge for patient satisfaction from hourly rounding. The use of call lights however decreased substantially based on the studies measured. Hourly rounds were associated with decreased calls for patient assistance in relation to repositioning, toileting, and other similar needs (Mitchell, et al., 2014). Repositioning is very much important in this case because it is seen to eventually reduce pressure ulcers, ultimately improving patient outcomes and reducing patient morbidities. Falls were significantly reduced following hourly rounding with patient satisfaction relatively addressed in this context.
In an earlier study by Blakley, Kroth, and Gregson (2011), the results supporting the importance of hourly rounding towards improving patient satisfaction were clearer as compared to the systematic study by Mitchell and colleagues (2014). In this study, the authors set out to establish the impact of nurse rounding on inpatients at a medical-surgical unit. The nurse rounding program was known as the 4 P program (positioning, pain, potty, and possessions) which is a nurse rounding program where the nurse makes patient rounds at least every 2 hours in order to anticipate and meet the patient’s basic needs (Blakley, Kroth & Gregson, 2011). The Gallup Organization gathered patient satisfaction data on a weekly basis (Blakley, Kroth & Gregson, 2011). Initial patient satisfaction scores, including interviews and related findings indicated that the 4 P rounding program significantly improved patient as well as employee satisfaction. This program which was the only program implemented on respondent patients for the year 2008 was notable for increasing patient satisfaction scores. The nurses also noted how their patients used their call light less and only to seek attention for their more serious needs. The patients also recall that their nurses were more likely to respond to their call lights almost immediately and their nurses were less rude to them after the 4 P program was introduced (Blakley, Kroth & Gregson, 2011). Overall, patient satisfaction following the introduction of the 4 P rounding program was significantly improved. This study is however implementing a program which is meant to promote rounding at least every two hours, which is less than the hourly rounding being studied in this paper. Nevertheless, this program is not significantly different from the hourly rounding as the 4 P program also represents a change in the usual routine of nurses in making their rounds. Both programs represent an increase and a regularization of nurse rounds with the end goal of improving nurse efficiency and patient satisfaction (Blakley, Kroth & Gregson, 2011). This study is however only limited to medical-surgical patients. This group of patients is however understandably more likely to have more needs as compared to other patients and is more likely to use the call light. The choice of patient population is understandable for the author’s purposes, but makes their results less generalizable to the larger population of patients admitted to the hospital setting.
Not all studies however showed clear satisfactory results related to hourly rounding. The pilot study by Gardner, Woollett, Daly and Richardson (2009) for instance indicated that results related to patient satisfaction indicated no significant changes. The authors wanted to measure how comfort rounds affected practice environment and patient satisfaction. They carried out their quasi experimental pre-test posttest non-randomized parallel design study on a study sample of 61 consenting patients and 23 nurses at the Royal Brisbane & Women’s Hospital in Brisbane, Australia (Gardner, et al., 2009). Hourly patient comfort rounds were undertaken for eight weeks on acute surgical wards and a patient satisfaction survey was later carried out to measure the impact of the rounds on patient satisfaction (Gardner, et al., 2009). The study did not reveal any statistically significant differences between the control and intervention groups and the responses clustered around strongly agree and agree options in both groups, hence the lack of significant difference between the two groups (Gardner, et al., 2009).
The Patient Satisfaction Survey did not present significant differences between the two groups but this can be attributed to the small sample size and a patient reluctance to complain about the quality of nursing care they are receiving (Gardner, et al., 2009). The limited sample size of this study was able to secure primary objectives. This study was able to develop a reliable patient satisfaction survey and it did support the idea that nurse-led and patient centered care can have favorable effects on the practice environment and potentially on patient safety which covers the use of the call light, the reduction of patient falls, and reduction of patient injuries (Gardner, et al., 2009). However, this study also highlights the need to test the use of hourly rounding on a larger population.
The study above does not completely discount or negate the favorable impact of hourly rounding on patient satisfaction. Halm (2009) for instance was able to point out how hourly rounds reduced the frequency of nurse call lights from patients and how it reduced patient injuries and falls. The author set out to review available evidence on how hourly rounds impact on inpatient settings. Halm (2009) highlighted how nursing rounds help ensure patient engagement, allowing nurses to check primarily on 4 Ps (pain, positioning, potty, and proximity of personal items). Hourly rounds meet patient expectations with patients less likely to become anxious about their needs not being met when they trust that their nurses would make hourly rounds. Halm’s (2009) review gathered evidence from 11 reports with assessments carried out in different hospital units, medical-surgical settings, gerontology settings, including orthopedic and rehabilitation units. In the different studies, majority of the interventions were carried out hourly by the nurses. One study was quasi-experimental and the others were quality improvement designs which were not sufficiently detailed in their analysis of related outcomes (Halm, 2009). Five out of six studies evaluated outcomes related to the use of call lights and in one study, the use of call lights was decreased (Halm, 2009). In one of the reports, nurses were called 12 to 15 times for non-urgent needs (Halm, 2009). In yet another study, there was a 20% decrease in distance walked as there were fewer calls via the call lights following the hourly rounds. The rate of falls was also decreased in 7 out of 9 of the studies (Halm, 2009). The Halm (2009) review also noted that more studies indicated that there was decreased need for patient restraints following the institution of hourly rounds. Majority of the studies indicated improvements in patient satisfaction and a greater likelihood for these patients recommending the hospital. Their sense of satisfaction was in the way the hourly rounds assisted nurses’ anticipation of their needs, in ensuring timeliness in the nurses’ delivery response, and in improving pain management.
A more qualitative approach to measuring patient satisfaction in relation to hourly rounding was undertaken by Allen, Rieck, and Salsbury (2016). Qualitative studies are likely to provide more personal perspectives and this study was no exception as the authors were able to gather information related to patient perceptions on hourly rounding and their hospital experience (Allen, Rieck & Salsbury, 2016). The authors conducted qualitative interviews with 14 adult medical/surgical inpatients in a mid-sized community hospital (Allen, Rieck & Salsbury, 2016). Themes related to patient experience including hospitalization experience, hourly rounding, and unexpected findings were generated. Patients considered that their emotional needs being met by the staff was very much significant to them (Allen, Rieck & Salsbury, 2016). Patients also felt that while hospital procedures were followed and explained by the nurses and staff, the treatment was not explained efficiently to them. Hourly rounding which served specific purposes was not noticeable to patients, nevertheless, they did notice rounds where the nurses did vital checks and medication passes (Allen, Rieck & Salsbury, 2016). The patients also noticed sleep interruptions and the decrease in their call light usage alongside hourly rounds. The patients also did not see their nurses as addressing their 4 Ps during their hourly rounds (Allen, Rieck & Salsbury, 2016). Instead, they saw their nurses as simply checking their vitals, administering the medications, or carrying out routine care. Some patients did however prefer not to press their call lights because they knew their nurses would return hourly. Sleep interruptions were however an unfavorable effect the patients noted from the hourly rounding (Allen, Rieck & Salsbury, 2016). Some patients complained that the hourly rounds kept them awake at night and that the nurses were more focused on doing their rounds rather than allowing them their rest.
We can do it today.
Conclusion
Based on the studies presented above, hourly rounding does improve the patient’s experience. The studies are able to acknowledge the importance of improving the link between the patient and the nurse in terms of meeting the latter’s basic needs. Hourly rounding helps ensure that the patient’s basic needs are addressed in a timely fashion which in turn ensures that they are less likely to press the call light and less likely to injure themselves or are less likely to experience falls in the hospital setting. There are however some methodological gaps including insufficient sample sizes in the studies above to cast doubt on the significant impact of hourly rounding on patient experiences. One of the studies also mentioned about some patients experiencing sleep interruptions due to hourly rounding. This and other related concerns on hourly rounding are however issues on how such rounds are carried out in the clinical setting. Improvements on how such rounds are undertaken are recommended in order to secure benefits of hourly rounding while avoiding its pitfalls.
- Allen, T., Rieck, T., & Salsbury, S. (2016). Patient perceptions of an AIDET and hourly rounding program in a community hospital: Results of a qualitative study. Patient Experience Journal, 3(1), 42-49.
- Blakley, D., Kroth, M., & Gregson, J. (2011). The impact of nurse rounding on patient satisfaction in a medical-surgical hospital unit. Medsurg Nursing, 20(6), 327.
- Gardner, G., Woollett, K., Daly, N., & Richardson, B. (2009). Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: A pilot study. International Journal of Nursing Practice, 15(4), 287-293.
- Halm, M. A. (2009). Hourly rounds: what does the evidence indicate?. American Journal of Critical Care, 18(6), 581-584.
- Mitchell, M. D., Lavenberg, J. G., Trotta, R., & Umscheid, C. A. (2014). Hourly rounding to improve nursing responsiveness: a systematic review. The Journal of nursing administration, 44(9), 462.