Hourly
Rounding℠:
So much
Impact in
So Few
Minutes
Lynne Mahony, MBA/MFA
Shelly Barber, RN, BSN
The Why
Hourly Rounding on patients is one of ten (10) new
ways hospitals can "see" differently. “Hourly
Rounding, developed by Studer Group, the largest
study ever focused on the impact of rounding. Hourly
Rounding “restores sanity and joy to our workforce.”
» Maureen Bisognano, COO of IHI 2007
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
GOAL: Hourly Rounding℠
with the 8 Nursing
Behaviors Hardwired
Once and For All!
Reduce call lights for increased nurse efficiency
and satisfaction
Reduce patient falls
Reduce skin breakdown
Improve patient perception of their care
Give nurses more time for patient care tasks
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Healthcare Flywheel
®
Hourly
Rounding
Bottom Line Results
Prescriptive
To Do’s
 Increased pt. sat
 Increased nurse
sat
 Fewer falls and
skin breakdown
reduce costs and
increase capacity
Purpose,
worthwhile work
and making
a difference
More time for
proactive
nursing
creates
passion
®
SelfMotivation
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Alliance for Health Care Research Study Profile:
22 hospitals participated
14 hospitals; 27 units used
in final data
Experimental and control
units in all hospitals
30% Non-Studer Group
partners (not in a contractual
relationship)
Unit breakdown:
44% Medical/Surgical
30% Surgical
26% Medical (oncology,
telemetry, neuro)
52% did one hour rounding
48% conducted two hour
rounding
*Largest study ever conducted on reducing call lights and the impact
of Hourly Rounding℠ on patient satisfaction and quality of care.
Published in American Journal of Nursing in 9/2006
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Call Light Reductions
After Implementing Rounds
13,216
15,000
Call Light Rings
9,316
12,000
8,315
9,000
6,000
1 Hour Rounding/29 beds
 37.8% reduction
3,000
0
Pre-Rounding
* Reduction for one-hour was
statistically significant (p=.000)
Weeks 1-2
One Hour
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Weeks 3-4
Service: Patient Satisfaction Increased
91.9
79.9
100
Overall Nursing
80
60
40
1 Hour Rounding
 +12.0 point mean increase
20
0
Pre One Hour Rounding
One Hour: n=18 units
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
During One Hour Rounding
Quality: Patient Falls Reduced
25
Patient Falls
30
25
20
12
15
10
5
1 Hour Rounding
 50% reduction
0
Pre One-Hour
(n=18 units)
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
During One hour
Quality: Skin Breakdown Reduced
10
7
Nosocomial Decubiti
8
5
6
4
1 Hour Rounding
 14% reduction
2
0
Pre One-Hour
(n=9 units)
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During One hour
One Hour Rounding:
Top Five Changes In Patient Requests
Rounding affected the 3 P’s:
 Pain (-35%)
3000
2500
2,379
 Potty (-40%)
 Position (-29%)
2000
1,628
1,424
1500
1,420
1,142
984
1000
744
868
507
361
500
0
Bathroom
All reductions were statistically
significant (p=.000)
Pain
Positioning
Pre-Round
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IV/Alarms
End Round
Misc
Alliance for Health Care Research Follow-up:
Purpose
ONE
YEAR
LATER
We wanted to understand:
If the study units continued the rounding after the
study was over;
If other units in the hospital adopted rounding;
What, if any, enhancements or adaptations were
made in the behaviors used for the study;
How their patient satisfaction scores and fall rates
have changed from the beginning of the study.
Note: This summary presents the data from 14
of the 22 whose data was used in the study.
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Findings:
85.7% of the units continued the rounding.
92.8% of the hospitals decided to expand the
rounding to other units or hospital-wide.
Patient satisfaction scores maintained a strong
increase over the early results.
Falls continued to reduce over the year.
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
ONE
YEAR
LATER
Quality: Patient Falls Reduced
30
25
ONE
YEAR
LATER
One Hour Rounding
 End of Study: 50% reduction
 One Year Later: 60% reduction
25
Patient Falls
20
12
10
15
10
5
0
Pre One-Hour Rounding
End of Study (APR05)
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One Year Later (APR06)
Service: Patient Satisfaction Sustained
91.9
100
88.8
79.9
Overall Nursing
80
60
One Hour Rounding:
 +8.9 point mean sustained increase
40
20
0
Pre One Hour Rounding
End of Study (APR05)
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One Year Later (APR06)
ONE
YEAR
LATER
Financial: Reduced Cost to Hospital
Decubitus:
• Nationwide estimates
indicate a hospital-acquired
decubitus case costs an
average of $15,958*
• The units in our study
reduced decubitus cases by
2 in 4 weeks. This equates
to a savings of $31,916.
Falls
• Falls cost a hospital an
average of $11,042 per
fall**
• The units in our study
reduced falls by 13; that
equates to a total of
$143,546.
* AHRQ, 2005-`Payments for
Adverse Events’
** National Center for Injury
Prevention, 2004; Rizzo, 1998
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What Is In It For Your Team?
Staff will have more time in a day to accomplish
tasks.
PROACTIVE TIME
Staff will run around less because of the reduced
call lights.
The units will be quieter and less hectic.
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
The What of
Hourly Rounding
Implementation Steps: Hourly Rounds
Train Nurse Leaders and Staff on
behaviors and key words
Solicit thoughts on barriers
Measure Frequency Of Call Lights
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
No Pass Zone
Review What Patient Will Consider a "Call Light" :
Call Light, Phones, Patient Yelling, Visitor Request
for Patient, etc.
What does No Pass mean to your team
Getting comfortable with intervention
What does no Pass mean to UConn Health Center
No patient left without assistance or having been
connected to someone who can assist
No one left lost
No trash left behind
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Exercise: Identifying Potential Barriers
1. What could keep employees
from doing a good job at
reducing call lights?
________________________
________________________
2. What objections will they have
to rounding?
________________________
________________________
3. How are you going to deal
with these objections?
________________________
________________________
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Establish a Baseline –
Call Light Log
CALL
LIGHT
REQUEST
How many call
lights ring in
your unit?
ROOM # /
BED #
TIME OF
CALL LIGHT
REASON FOR CALL LIGHT *
1
422/1
6am
potty
2
423/1
6:24am
Reposition back to bed
3
410
7am
TV
4
417
7:10am
potty
5
423
6am
potty
6
420/1
6am
potty
7
414
6am
potty
8
412
6am
potty
9
408
6am
potty
10
423/1
6am
potty
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Implementation Steps
Gather other baseline measures
Patient Experience (HCAHPS) / Patient Satisfaction
Number of Falls
Hospital-acquired decubiti
Other items of interest to you or your units such as med error rates,
efficiency factor such as pedometers
Set your goals for reductions- AHCR range of reductions
ranged from 13%-75%. Larger reductions had strong
nurse managers at the helm.
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Implementation Steps
Define parameters for one hour rounding for staff
One hour rounds from 6 am-10 pm.
From 10 pm-6 am two hour rounds to respect patients’
sleeping patterns
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.
Reinforce the difference between
“checking in” every hour
and performing the eight behaviors
associated with Hourly Rounding℠
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Eight Behaviors for hourly rounds
Hourly Rounding Behavior
Expected Results
Use Opening Key words
Contributes to efficiency
Accomplish scheduled tasks
Contributes to efficiency
Address 3 P’s (pain, potty, position)
Quality indicators – falls, decubitis,
pain management
Address additional comfort needs
Improved patient satisfaction on pain,
concern and caring
Conduct environmental assessment
Contributes to efficiency, teamwork
Ask “Is there anything else I can do
for you before I go, I have time?”
Contributes to efficiency
Improves patient satisfaction on
teamwork and communication
Tell each patient when you will be
back
Contributes to efficiency
Document the round
Quality and accountability
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Hardwiring, Validating, Accountability
Train the staff
Validate staff competency
Create the promise
Log the rounds
Leaders round on patients
Report results- create a score card
Weekly Nurse Leader Huddles
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More Accountability tools
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While you were sleeping cards
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Getting Good Results: You’re the Coach
Supervise staff ‘shadow’ rounding, ensure compliance.
Meet with staff - understand objections and encourage
teamwork.
Counsel staff members not rounding.
Share results weekly.
Celebrate success!
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Weekly Nurse Leader Stand up Huddles
Schedule a weekly hourly rounding meeting led by Director
(someone the leaders report to) to drive accountability.
Include units currently doing hourly rounding and those
planning to come up in the future.
Agenda
What is going well? Share letters, stories, staff feedback
What are barriers identified? Problem solve solutions
What are the tough questions?
Review the patient satisfaction by unit for the week
Review the % of competency check sheets completed for the
week
Review the rounding logs and daily rounding sheets for the
past 24 hour period
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Ancillary Departments:
Environmental Assessment
Ancillary Staff can practice behaviors to ensure
patient needs are met and reduce call lights.
Use behaviors to manage
up experience and inform
what they are there to do.
Use key words:
Is there anything I have
missed?
Is there anything I can do
for you before I leave?
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Conduct an environmental
assessment and make sure
key items are in reach (i.e.
call light, telephone, TV
control, bed light switch,
Kleenex box, garbage can,
etc.)
Customizing for Specialty units
OB- (SKIP)
Supplies, Komfort, Information, Personal needs
Psych- Privacy, Food, Plan of Care,
NICU- Parents, Pain, Positioning
ICU- Alarms, Plan of care, Questions/Information
Pediatrics- Pain, Potty, Play, Pumps, Questions
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OB Rounding Behaviors that Reduce Call
Lights
• Supply Needs
Diapers
Pads
• Komfort Needs
Blanket
Cot for Dad
Pain Control
• Informational Needs
Feeding baby
Car Seat
• Personal Needs
Toileting
Shower
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“A man who dares to
waste one hour of time
has not discovered the
value of life
“If you don’t have
time to do it right,
when will you have
time to do it over?”
Wooden
“We must alwaysJohn
use
time
wisely and forever realize
that the time is always
ripe to do right “
Charles Darwin
Nelson Mandela
Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.