LITERATURE REVIEW: Hourly Rounding Articles
TITLE: Hourly Rounding Articles
SEARCH TERMS USED: “Hourly Rounding;” “Intentional Rounding;” and “Purposeful Rounding”
BRIEF SUMMARY OF FINDINGS:
Positive Results of Hourly Rounding:
A protocol that incorporates specific actions into nursing rounds conducted either hourly or once every two
hours can reduce the frequency of patients' call light use, increase their satisfaction with nursing
care, and reduce falls.8 (Meade, C. et al)
Hourly ward rounds improve care and reduce staff stress.2
Hourly rounds reduce call lights.6
The I Care Rounding model places the emphasis on proactively meeting patient needs through hourly
rounding, rather than caregivers providing care in a reactionary mode. After full implementation, positive
improvement was demonstrated.5
One Study Found Hourly Rounding Showed No Significant Changes in Patient Satisfaction:
Hourly rounding in the acute hospital setting has been proposed as an intervention to increase patient satisfaction
and safety, and improve the nursing practice environment. Results on patient satisfaction showed no significant
changes. Significant changes were found for three of the five practice environment subscales.4
Ways to Successfully Implement Hourly Rounding Include Careful Planning, Communication & Evaluation:
Introduction of evidence-based practices such as hourly rounding can be difficult. Careful planning, communication,
implementation and evaluation are required for successful implementation.1
Other Types of Rounding found in the Literature: Multidisciplinary, Family-Centered & ED:
Multidisciplinary rounds are a low-cost medical intervention with proven benefits.9
The key difference between family-centered rounds and traditional bedside teaching is the active
participation of the patient and family in the discussion. Interdisciplinary care implies that professionals
from a variety of disciplines work collaboratively to develop a unified care plan. Family-centered rounding
provides an interface between families and medical professionals that allows education of medical
students and residents as well as the development of a unified care plan.10
Rounding in the ED reception and treatment areas is effective and improves outcomes.11
CITATIONS:
J Nurs Care Qual. 2011 Jul 5. [Epub ahead of print]
1. Hourly Rounding: Challenges With Implementation of an EvidenceBased Process.
Deitrick LM, Baker K, Paxton H, Flores M, Swavely D.
Source
Division of Community Health and Health Studies, Lehigh Valley Health Network, Allentown, Pennsylvania.
Abstract
Introduction of an evidence-based practice change, such as hourly rounding, can be difficult in the hospital setting.
This study used ethnographic methods to examine problems with the implementation of hourly rounding on 2 similar
inpatient units at our hospital. Results indicate that careful planning, communication, implementation, and
evaluation are required for successful implementation of a nursing practice change.
PMID: 21734597
Date Completed:
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LITERATURE REVIEW: Hourly Rounding Articles
Nurs Manag (Harrow). 2010 Nov;17(7):6-7.
2. Hourly ward rounds improve care and reduce staff stress.
Duffin C.
PMID: 21158341
Am J Crit Care. 2009 Nov;18(6):581-4.
3. Hourly rounds: what does the evidence indicate?
Halm MA.
Source
Salem Hospital in Salem, Oregon, USA.
PMID: 19880960
Int J Nurs Pract. 2009 Aug;15(4):287-93.
4. Measuring the effect of patient comfort rounds on practice
environment and patient satisfaction: a pilot study.
Gardner G, Woollett K, Daly N, Richardson B.
Source
Centre for Clinical Nursing, Royal Brisbane & Women's Hospital and Queensland University of Technology,
Queensland, Australia. ge.gardner@qut.edu.au
Abstract
Hourly rounding in the acute hospital setting has been proposed as an intervention to increase patient satisfaction
and safety, and improve the nursing practice environment, but the innovation has not been adequately tested. A
quasi-experimental pretest post-test non-randomized parallel group trial design was used to test the effect of hourly
patient comfort rounds on patient satisfaction and nursing perceptions of the practice environment, and to evaluate
research processes and instruments for a proposed larger study. A Patient Satisfaction Survey instrument was
developed and used in conjunction with the Practice Environment Scale of the Nursing Work Index. Results on
patient satisfaction showed no significant changes. Significant changes were found for three of the five
practice environment subscales. Consistent with the aim of a pilot study, this research has provided important
information related to design, instruments and process that will inform a larger sufficiently powered study.
PMID: 19703045
Orthop Nurs. 2008 Jul-Aug;27(4):233-40; quiz 241-2.
5. Proactive patient rounding to increase customer service and
satisfaction on an orthopaedic unit.
Tea C, Ellison M, Feghali F.
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LITERATURE REVIEW: Hourly Rounding Articles
Source
Inova Fair Oaks Hospital, Fairfax, VA, USA.
Abstract
Customer service and patient satisfaction have become increasingly important in the healthcare industry. Given
limited resources and a myriad of choices, on which facets of patient satisfaction should healthcare providers focus?
An analysis of 40,000 observations across 4 hospitals found 1 important intervention: timely staff responsiveness.
Using the Plan-Do-Check-Act (PDCA) quality methodology, the goal was set to improve staff responsiveness to
orthopaedic patient needs and requests, thus improving patient satisfaction. A model to improve staff responsiveness
was systematically developed and implemented. The I Care Rounding model places the emphasis on proactively
meeting patient needs through hourly rounding, rather than caregivers providing care in a reactionary mode.
After full implementation, positive improvement was demonstrated.
PMID: 18677250
Nurs Manage. 2008 Mar;39(3):50-2.
6. Reduce call light frequency with hourly rounds.
Culley T.
Source
Western Pennsylvania Hospital, Pittsburgh, PA, USA.
PMID: 18414227
Okla Nurse. 2006 Dec-2007 Feb;51(4):11.
7. Hourly rounding for positive patient and staff outcomes: fairy tale
or success story?
Orr N, Tranum K, Kupperschmidt B.
PMID: 17140005
Am J Nurs. 2006 Sep;106(9):58-70; quiz 70-1.
8. Effects of nursing rounds: on patients' call light use, satisfaction,
and safety.
Meade CM, Bursell AL, Ketelsen L.
Source
Alliance for Health Care Research, Studer Group, Gulf Breeze, FL, USA. chris.meade@studergroup.com
Date Completed:
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LITERATURE REVIEW: Hourly Rounding Articles
Abstract
OBJECTIVE:
There is limited research on patient call light use as it pertains to effective patient-care management, patient safety,
and patient satisfaction. Therefore, this study sought to determine the frequency of and reasons for patients' call light
use, the effects of one-hour and two-hour nursing rounds on patients' use of the call light, and the effects of such
rounding on patient satisfaction, as well as patient safety as measured by the rate of patient falls.
METHODS:
A six-week nationwide study was performed using a quasi-experimental nonequivalent groups design; baseline data
was taken during the first two weeks. Analyses were performed on data from 27 nursing units in 14 hospitals in which
members of the nursing staff performed rounds either at one-hour or two-hour intervals using a specified protocol.
RESULTS:
Specific nursing actions performed at set intervals were associated with statistically significant reduced patient use of
the call light overall, as well as a reduction of patient falls and increased patient satisfaction.
CONCLUSIONS:
A protocol that incorporates specific actions into nursing rounds conducted either hourly or once every two
hours can reduce the frequency of patients' call light use, increase their satisfaction with nursing care, and
reduce falls. Based on these results, we suggest operational changes in hospitals, emphasizing nurse rounding on
patients to achieve more effective patient-care management and improved patient satisfaction and safety.
Comment in
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
Am J Nurs. 2007 Feb;107(2):15-6.
Am J Nurs. 2007 Feb;107(2):16.
PMID: 16954767
Cardiac Surgery Rounds
Ann Thorac Surg. 2009 Sep;88(3):809-13.
9. Dissecting multidisciplinary cardiac surgery rounds.
Cardarelli M, Vaidya V, Conway D, Jarin J, Xiao Y.
Source
Department of Surgery, Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore 21201,
Maryland, USA. mcard001@umaryland.edu
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LITERATURE REVIEW: Hourly Rounding Articles
Abstract
BACKGROUND:
Multidisciplinary rounds in the critical care environment have demonstrated increased communication, a reduction in
medical errors, a shorter hospital stay, and consequently, economic savings. We attempt to assess the cost of this
intervention, and to review the time utilization of professionals participating in the process.
METHODS:
We analyzed video-recorded weekly multidisciplinary teaching rounds on cardiac patients in a pediatric intensive care
unit (n = 22). Rounding time was categorized as presentation or discussion and was measured in minutes. The cost
of a round was calculated by multiplying the hourly salary of all healthcare professionals present by the time spent
rounding and measured in US dollars.
RESULTS:
Median rounding time per patient was 15 minutes (range, 5 to 29). Patient presentation took between 2 and 8
minutes (median 4), or 26% of the rounding time. Time needed for discussion, including teaching and planning,
varied between 2 and 25 minutes (median 10.5). Median number of participants was 13.5 (range, 11 and 16). Mean
cost in salaries per patient rounded was $140.87 (95% confidence interval: $106.80 to $174.90).
CONCLUSIONS:
Multidisciplinary rounds are a low-cost medical intervention with proven benefits. Available tools and rounding
cultural changes should be adopted to shorten data retrieval and presentation time to the benefit of discussion and
teaching. Current billing requirements for rounding multidisciplinary teams do not reflect the realities of their time use.
Comment in

Ann Thorac Surg. 2010 Mar;89(3):1010.
PMID: 19699903
Family Centered Rounds
Teach Learn Med. 2007 Summer;19(3):319-22.
10.
Defining family-centered rounds.
Sisterhen LL, Blaszak RT, Woods MB, Smith CE.
Source
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202, USA.
Sisterhenlaura1@uams.edu
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LITERATURE REVIEW: Hourly Rounding Articles
Abstract
BACKGROUND:
Physicians are required to provide safe, effective, and high-quality care that is patient-centered. Continuing to meet
the educational needs of residents and medical students in the setting of patient-centered care will require developing
new models for hospital "work rounds." Family-centered rounds is a model of communicating and learning between
the patient, family, medical professionals, and students on an academic, inpatient ward setting. Unfortunately, in the
medical literature, there is no consensus on the definition of family-centered rounds.
SUMMARY:
Despite the increased utilization of hospitalists and the recognition that bedside teaching has many benefits, bedside
rounds are underutilized. In this article, we present a description of family-centered rounds that is supported by a
review of the literature on bedside teaching, family-centered care, and interdisciplinary care. The key difference
between family-centered rounds and traditional bedside teaching is the active participation of the patient and
family in the discussion. Interdisciplinary care implies that professionals from a variety of disciplines work
collaboratively to develop a unified care plan. Family-centered rounding provides an interface between
families and medical professionals that allows education of medical students and residents as well as the
development of a unified care plan.
CONCLUSIONS:
Family-centered rounds hold potential to create a patient-centered environment, enhance medical education,
and improve patient outcomes. The model is a planned, purposeful interaction that requires the permission of
patients and families as well as the cooperation of physicians, nurses, and ancillary staff.
PMID: 17594229
ED Rounds
J Emerg Med. 2010 Jun;38(5):666-74. Epub 2008 Oct 8.
11.
The effects of emergency department staff rounding on
patient safety and satisfaction.
Meade CM, Kennedy J, Kaplan J.
Source
Analytic Research Associates, Waynesboro, Virginia, USA.
Abstract
BACKGROUND:
Two recent inpatient studies documented that regular nursing staff rounding increased patient safety and satisfaction.
However, the effect of systematic emergency department (ED) staff rounding on patient safety and satisfaction has
not been adequately tested.
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LITERATURE REVIEW: Hourly Rounding Articles
STUDY OBJECTIVE:
The objective of this study was to test the effectiveness of three different rounding techniques.
METHODS:
An 8-week study using a quasi-experimental, non-equivalent group, time-sampling design was conducted in 28 EDs.
The three rounding protocols were: 1) rounds every 30 min; 2) rounds every hour; 3) rounds every hour with an
Individualized Patient Care tactic (IPC; patients were asked to name their most important expectation for the ED
visit). Baseline data were collected the first 4 weeks; rounding was done the second 4 weeks. Outcome measures
compared the baseline to the rounding period data for patients who left without being seen (LWBS), those leaving
against medical advice (AMA), patient satisfaction, call light use, and nursing station encounters. Results: The three
rounding protocols combined reduced LWBS by 23.4%, leaving AMA by 22.6%, falls by 58.8%, call light use by
34.7%, and approaches to the nursing station by 39.5%. Patient satisfaction ratings for overall care and pain
management increased significantly. The protocol using the IPC tactic produced the most significantly improved
outcomes.
CONCLUSIONS:
Rounding in the ED reception and treatment areas is effective and improves outcomes. Further research
should determine the optimal design for rounding considering the mixed shifts in EDs, seek ways to increase
communicating delays to patients, and investigate how to integrate rounding with physician activities.
Copyright 2010 Elsevier Inc. All rights reserved.
PMID: 18842381
Date Completed:
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