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Hourly Rounding Strategy Dims Nurse Call Light Volume

Monday January 15, 2007
Christine Shields, RN, CMSRN, assistant nurse manager, answers a phone call at a nurse’s station at the Medical Center of Plano in Texas.
Christine Shields, RN, CMSRN, assistant nurse manager, answers a phone call at a nurse’s station at the Medical Center of Plano in Texas.
(Photo by Terry Cockerham.)
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Brook Steele, RN
A new strategy of hourly rounding has created a comfort zone for patients and allows better control over the flow of work for Brook Steele, RN, a busy pediatrics nurse at Sacred Heart Hospital in Eau Claire, Wis.

Since her unit launched a proactive approach to meeting patient needs, Steele has seen a sharp drop in call lights going off at inopportune moments.

“On days when the protocol works perfectly, when we’re able to see patients every hour on the hour, those are the days when call lights go off once or twice or not at all during a shift,” says Steele. “It can put you a little more in charge of your own day.”

In a growing number of small and large hospitals across the country, nurses involved in a results-driven, 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 interest in rounding comes in the wake of research results from 27 nursing units in 14 hospitals showing a consistent strategy of checking on patient needs effectively reduces monthly call light use by 38%, patient falls by 50%, and skin breakdowns by 14% while satisfaction scores move upward. The results were published in the study “Effects of Nursing Rounds on Patients’ Call Light Use, Satisfaction, and Safety,” in the September 2006 American Journal of Nursing.

Study sparks wide interest

“The response has been amazing,” says Christine Meade, PhD, chief researcher and healthcare coach with the Studer Group’s Alliance for Healthcare Research in Gulf Breeze, Fla. “Nurses know rounding works, especially those who have been practicing for 20 years, but nobody’s ever done a study to prove it.”

Meade, a co-author of the study, says she gets about 10 e-mails a day about the research results and is part of a team of coaches who are helping to launch the rounding protocol in dozens of hospitals, including some in Indiana, Ohio, Wisconsin, and Minnesota. An interactive training video toolkit also is available that shows study data and demonstrates how recommended behaviors and actions by nurses on hourly rounds can improve efficiencies and satisfaction rates, giving nurses more time.

“It’s essentially like adding the time of one full-time RN to complement the staff for a week because of the hours not used answering call lights –– and the patients love it,” says Meade.

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


Faye Deich, RN
Cultural shift

At Sacred Heart, two nurses in med-surg units participated in last year’s pilot study and agreed to follow a Studer Group script of hourly rounding. The process proved successful and the concept is being implemented by more than 400 nurses throughout the facility, says Faye Deich, RN, MS, CNAA, chief nursing officer.

“It’s really a cultural shift for the nursing staff,” says Deich. “They’re moving toward a more pro-active approach to care instead of waiting for patients to call in and interrupt what they’re doing.”

As implementation of the protocol nears 100% at the hospital, nursing directors audit the progress by making their own rounds, asking patients if nurses come in every hour and follow the rounding procedure. Nurses also document what takes place during each round.

“It takes attention and focus to make sure that we’re fully implemented and that the process sticks, and that’s where we’re at right now,” says Deich.

The strategy calls for nurses or nursing assistants to greet each patient, introduce themselves, explain they’re making their hourly rounds, and ask if they have any needs or questions. A specific focus is put on the “three P’s” –– pain, potty, positioning –– followed by assuring the patients a nurse will be back in an hour.

Proactive vs. reactive

Lyn Ketelsen, RN, MBA, is a Studer Group coach and co-author of the hourly-rounding study who originated the research project after visiting numerous hospitals 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 them well and they needed to transition to a more proactive nursing approach.”

The researchers set up specific tactics for hourly rounding that assured 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 reminding patients a nurse would return within an hour, or in some cases two hours, especially at night.

“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.”

Informally, she had nurses wear pedometers at one hospital and found they walked 5.2 miles per shift prior to implementing hourly rounding and 4.3 miles per shift afterward. “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.”

Improving efficiencies

While the exact metrics aren’t available, units at Sacred Heart where the protocol has been “hardwired” into the routine not only show a drop in call lights but a decline in patient falls, a reduction of skin breakdowns, and an upward trend in patient satisfaction similar to that of the national study. A survey on nursing satisfaction will be made in early 2007 and should be highly judged by the enthusiasm for the program by nursing councils in the hospital’s shared governance model, says Deich.

Steele, who is chair of the hospital’s quality council, says nurses have learned they can stay ahead of patient needs and help them feel more comfortable about asking questions and communicating with their caregivers. She says boards kept in each room give specifics on patient treatments and have comment sections to pass on information.

These could be notes on keeping on top of the No.1 complaint or something as simple as noting that a patient doesn’t like ice in his or her water, says Steele. “Little things often make a difference,” she says.

Some nurses initially balked at hourly rounding over concerns it would make their shifts busier, which is proving untrue, says Steele. “We’re not adding more work, we’re just working smarter,” she says.

Quick rollout at South Pointe

South Pointe Hospital in Cleveland had 50 nurses in a 43-bed med-surg unit take part in the Studer Group study and almost immediately took the hourly rounding practice to 450 nurses hospital-wide.

“Every floor has rounding boards on the doors,” says chief nursing officer Sue Collier, RN, MSN. “Hourly rounding clearly demonstrated a positive impact on patient care, and we are excited to continue it.”

She says nurses no longer go in a patient’s room and just say, “Hi, how are you?” look around, and leave. Instead, they ask, “Can you reach the telephone?” or “Can I help you to the bathroom?”

Collier says it takes a commitment by management to make hourly rounding successful since nurses can easily get busy and fall back into a reactive mode.
“We keep showing nurses the time-saving benefits from the protocol,” says Collier. “What’s in it for the patient is a better stay.”

Sudden impact

Researcher Ketelsen says she experimented with hourly rounding while coaching at hospitals for nearly a year before helping to launch the formal study that resulted in an inpatient protocol used by many hospitals across the country.

While nurses are professional and have the interests of their patients in mind, changing work habits is difficult, which is why the researchers developed a formal set of behaviors for nurses to follow, says Ketelsen.

“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,” she says.



John Leighty is a freelance writer. To comment, e-mail hcygan@gannetthg.com.

Three P’s rule

    Position: Making sure the patient is comfortable and assessing the risk of pressure ulcers
    Potty (personal needs): Scheduling patient trips to the bathroom to avoid unsafe conditions. Otherwise, patients may try to get up themselves and not be strong enough, which can lead to falls.
    Pain: Asking patients to describe their pain level on a scale of zero to 10 and doing whatever is necessary to help