Bib List: Hourly Rounds
IHI Falls Expedition, Session 5.
Pat Quigley, PhD, ARNP, CRRN, FAAN, FAANP
Nurs Manag (Harrow). 2012 May;19(2):12-6.
1. Regular ward checks raise standards of care.
Dean E.
Source
nick.lipley@nursingmanagement.co.uk
Abstract
This article reports on the introduction of intentional rounding at University Hospitals Coventry and
Warwickshire NHS Trust. The approach was piloted and implemented on the initiative of two nurses in
wards that ranged from orthopedic to general medical. Intentional rounding aims to put patients at the
center of care and consists of checking on their condition at hourly or two-hourly intervals, recording their
nutritional status and skin integrity, and asking if they need pain relief or help with eating. The introduction
of the approach follows concerns about failures in care highlighted by a number of recent high-profile
reports.
PMID: 22690424
J Nurs Adm. 2012 Jun;42(6):326-332.
2. Hourly Rounding Implementation: A Multisite Description of
Structures, Processes, and Outcomes.
Rondinelli J, Ecker M, Crawford C, Seelinger C, Omery A.
Source
Author Affiliations: Project Manager (Ms Rondinelli) and Project Manager (Ms Crawford), Southern
California Kaiser Permanente Regional Nursing Research Program, Pasadena; Nursing Quality Director
(retired) (Ms Ecker), Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles;
Perinatal Director (Ms Seelinger), South Bay Medical Center, Kaiser Permanente Southern California,
Harbor City; Nurse Scientist and Director of the Regional Nursing Research Program (Dr Omery), Kaiser
Permanente, Southern California, Pasadena, California.
Abstract
OBJECTIVE:
This study identifies structures, processes, and outcomes associated with hourly nurse rounding.
BACKGROUND:
Literature supports that nurse rounding every 1 to 2 hours affects quality outcomes. Evidence is lacking
regarding the process of successful implementation.
METHODS:
Using an action research design, project leads implementing hourly rounding at 11 Southern California
hospitals agreed to recorded telephone interviews. Transcribed interviews underwent content analysis.
RESULTS:
Analysis revealed 15 major themes. Structure themes include use of rounding behaviors described
through an acronym and collaborative phone call. Processes include a library of tools to use incorporating
both patient and staff feedback. Patient satisfaction and patient perception of being well cared for are 2
common outcome themes.
CONCLUSIONS:
This study provides evidence that frequent reevaluation of structures and processes promote
achievement of desired outcomes in relation to hourly rounding. The authors recommend abandonment
of routinization and adoption of flexibility to sustain successful implementation of hourly rounding.
PMID: 22617698
Medsurg Nurs. 2012 Jan-Feb;21(1):23-6, 36.
3. Hourly rounding: a replication study.
Olrich T, Kalman M, Nigolian C.
Source
Crouse Hospital, Syracuse, NY, USA.
Page 1 of 8
Bib List: Hourly Rounds
IHI Falls Expedition, Session 5.
Pat Quigley, PhD, ARNP, CRRN, FAAN, FAANP
Abstract
Preventing falls in hospitalized patients, increasing patient satisfaction, and decreasing call light usage
are constant challenges nurses face every day. This quasi-experimental study replicates Meade, Bursell,
and Ketelsen's (2006) study on a rounding protocol, demonstrating improvements in the above variables.
PMID: 22479871
J Emerg Nurs. 2012 Jan;38(1):69-72. Epub 2011 Dec 5. . – No abstract available
4. Hourly rounding in the emergency department: how to accelerate
results.
Baker SJ.
Source
Studer Group, FL 32561, USA. stephanie.baker@studergroup.com
-Hourly rounding on patients in the ED addresses 3 priorities of all ED patients: pain, plan of care, and
delays.
-Key to accelerating clinical, service, and financial gains from hourly rounding is validating staff
accountability through leader rounding on patients, hardwiring the use of rounding logs, and providing
real-time feedback to staff.
PMID: 22153827
Worldviews Evid Based Nurs. 2012 Feb;9(1):18-29. doi: 10.1111/j.1741-6787.2011.00227.x. Epub 2011
Sep 19.
5. Outcomes and challenges in implementing hourly rounds to
reduce falls in orthopedic units.
Tucker SJ, Bieber PL, Attlesey-Pries JM, Olson ME, Dierkhising RA.
Source
Department of Nursing & Patient Care Services, University of Iowa Hospitals & Clinics, Iowa City, IA
52242-1009, USA. Sharon-tucker@uiowa.edu
Abstract
BACKGROUND:
Patient falls remain a common adverse event in acute care facilities. Findings from research into
structured nursing rounds interventions (SNRIs) indicate promise as a fall prevention practice.
Translating, adapting, and sustaining SNRI in real world clinical practices is an important next step.
AIM:
The purpose of this study was to evaluate the feasibility of adapting and translating a SNRI to reduce the
risk and incidence of patient falls on two orthopedic inpatient units. It was hypothesized that SNRI would
reduce fall rates up to 1-year postintervention and that patient risk factors and documented SNRI
activities would predict falls.
METHODS:
Using a repeated measures design, fall rates and risk assessment data were collected at baseline, during
the 12-week SNRI implementation, and 1-year following implementation. The adapted SNRI included
hourly prescribed rounding activities documented on a study specific form. Medical records of patient falls
were reviewed for each period. Focus groups were conducted with nurses' postintervention.
RESULTS:
Observed (probability) fall rates were 1.8%, 0.8%, and 1.1% for the three periods, respectively. Numbers
of falls per 1,000 hospital days (incidence) were 4.5, 1.6, and 3.2 for the three periods. Mean fall risk
assessment scores were 2.7 ± 1.1, 2.7 ± 1.1, and 2.5 ± 1.1 for the three periods. Fall rates declined
during SNRI (borderline trend), yet 1-year follow-up rates drifted back toward baseline. SNRI dosage and
fall risk scores did not predict fall rates. Patients who fell during the three periods were not at greatest
risk. Nurses interpreted SNRI as an imposition and the documentation a burden.
Page 2 of 8
Bib List: Hourly Rounds
IHI Falls Expedition, Session 5.
Pat Quigley, PhD, ARNP, CRRN, FAAN, FAANP
CONCLUSIONS:
Findings illuminate the multiple challenges in translational research. SNRI appeared to reduce fall rates
initially, but fidelity to the SNRI implementation and documentation was variable and fall reduction gains
appeared lost 1 year later. Nurses expressed the importance of balancing intervention fidelity and
individualizing patient interventions.
©2011 Sigma Theta Tau International.
PMID: 21929657
J Nurs Care Qual. 2012 Jan-Mar;27(1):13-9.
6. 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 18105, USA. Lynn.Deitrick@lvhn.org
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
Nurs Manag (Harrow). 2010 Nov;17(7):6-7. – No abstract available
7. Hourly ward rounds improve care and reduce staff stress.
Duffin C.
PMID: 21158341 [PubMed - indexed for MEDLINE]
-Article about hospitals in UK adopting Hourly Rounding based on study by Meade et al (2006)
-3 Hospitals that started hourly rounding include: Bupa Cromwell Hospital in Kensington & Chelsea and
two at Croydon Health Services NHS Trust & Whipss Cross University Hospital NHS Trust
-So far this is proving successful – patient satisfaction surveys were to be administered
-One person said that hourly rounding provides a more controlled environment and has reduced
nurses’ workload because they do not have to respond to so many call bells.
-Staff at the Cromwell and Croydon said the initiatives have been going for too short a time.
-One patient satisfaction survey shows that they are more satisfied since hourly rounds were
introduced
Nurs Manage. 2008 Mar;39(3):50-2. – No abstract available
8. Reduce call light frequency with hourly rounds.
Culley T.
Western Pennsylvania Hospital, Pittsburgh, PA, USA.
PMID: 18414227 [PubMed - indexed for MEDLINE]
-This study was to pattern hourly rounds around proven research, help nursing staffs gain control of their
workload, save time by reducing “busy work,” and increase patient satisfaction scores
-Education was required, and consistent follow up on a near daily basis with each staff hospital were
imminent
-Baseline data were collected prior to education and the initiation of hourly rounds
-When adjusted for patient census, the call light reductions were 77% on the step-down unit, 31%
on the surgical unit and 56% on the medical unit
-Improvements in patient satisfaction proved to be a motivate for continuing rounds
Page 3 of 8
Bib List: Hourly Rounds
IHI Falls Expedition, Session 5.
Pat Quigley, PhD, ARNP, CRRN, FAAN, FAANP
-Pilot was enough of a success to convince executive leadership to implement the project on
several more units.
-Hourly rounding continues to be a process and will be adjusted to meet individual unit needs
-Success comes in the form of call light reduction or an increase in patient satisfaction scores
-Dedicated education and staff champions are a must since a large part of nursing rounds is adjusting
staff priorities and attitudes
-Time spent on the project is worth it, as it has a direct correlation on results
Am J Crit Care. 2009 Nov;18(6):581-4. . – No abstract available
9. Hourly rounds: what does the evidence indicate?
Halm MA.
Salem Hospital in Salem, Oregon, USA.
PMID: 19880960 [PubMed - indexed for MEDLINE] ISSN: 1062-3264 PMID: 19880960 CINAHL AN: 2010464309

Halm (2009) conducted an evidence review to look at the effects of hourly rounding on various outcomes

Compilation of 11 reports were gathered and reviewed:
For those studying call light usage, it was found that 83% of studies noted a reduction in call light usage
Fall rates decreased in 77% of studies evaluated
Overall patient satisfaction increased in 88% of studies which included satisfaction with pain
management
MEDSURG Nursing 2010 May:10 (3) 188-91
10.
Hourly Rounding: A Strategy to Improve Patient Satisfaction
Scores.
Ford B
Excerpt from Article:
MEDSURG Nursing—May/June 2010—Vol. 19/No. 3 Purpose: The use of a proactive hourly rounding
strategy to improve patient satisfaction is described. Inspired by the work of Meade, Bursell, and Ketelsen
(2006), staff at Baltimore Washington Medical Center (BWMC) piloted hourly rounding on several units.
Although results from this study are not yet available, a brief case study can demonstrate how
results at BWMC may compare to the national study. The study’s purpose was to determine if patient
satisfaction increases significantly. ISSN: 1092-0811 CINAHL AN: 2010701196
http://www.britannica.com/bps/additionalcontent/18/51701522/Hourly-Rounding-A-Strategy-to-ImprovePatient-Satisfaction-Scores
Int J Nurs Pract. 2009 Aug;15(4):287-93.
11.
Measuring the effect of patient comfort rounds on practice
environment and patient satisfaction: a pilot study.
Gardner G, Woollett K, Daly N, Richardson B.
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.
Page 4 of 8
Bib List: Hourly Rounds
IHI Falls Expedition, Session 5.
Pat Quigley, PhD, ARNP, CRRN, FAAN, FAANP
PMID: 19703045 [PubMed - indexed for MEDLINE] ISSN: 1322-7114 PMID: 19703045 CINAHL AN: 2010378859
Worldviews Evid Based Nurs 2007; 4(4):220-3. – No abstract available
12.
The latest evidence on hourly rounding and rapid response
teams in decreasing adverse events in hospitals. [Cites review of
USPSTF methodology (Am J Prev Med, 2001).]
Melnyk BM. ISSN: 1545-102X PMID: 18076465 CINAHL AN: 2009863793
-This is an Evidence Digest to provide concise summaries of well-designed and/or clinically important
recent studies along with implications for practice, research, administration and/or health policy.
-This is an analysis of the Meade et al hourly rounding study
-Critique on research method used regarding random assignment
-Despite substantial threats to the validity of the study, the evidence is compelling and suggests
that hourly rounding may lead to increased patient satisfaction and a decrease in patient falls in
hospitals
-Further research is needed that uses randomized controlled trials because they are the strongest design
for testing cause and effect relationships
Oncology Nursing Forum, 2009 May; 36 (3): 72 (journal article – abstract, research) – No abstract available
13.
Medication review and hourly nursing rounds: an evidencebased approach reduces falls on oncology inpatient units.
Callahan L; McDonald S; Voit D; McDonnell A; Delgado-Flores J; Stanghellini E; ISSN: 0190-535X
CINAHL AN: 2010340939
-Purpose was to evaluate hourly nursing rounds and prospective review of high risk
medications on reduced falls and injury rates and increased patient and staff satisfaction
-On the Hematology-Oncology/Bone Marrow Transplant (HOB) service, the unit with the highest
injury rate was selected to implement rounds for 3 months.
-There were 3 falls with injury during the 3 months prior to the study and no falls during the
study period
-Press Ganey scores reflected increased patient satisfaction during this quarter, as compared
to the previous quarter
-Results were mirrored by overwhelmingly positive feedback from patients. Staff also reported
increased satisfaction related to teamwork and relationships.
Orthop Nurs. 2008 Jul-Aug;27(4):233-40; quiz 241-2.
14.
Proactive patient rounding to increase customer service and
satisfaction on an orthopaedic unit.
Tea C, Ellison M, Feghali F.
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:
Page 5 of 8
Bib List: Hourly Rounds
IHI Falls Expedition, Session 5.
Pat Quigley, PhD, ARNP, CRRN, FAAN, FAANP
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
Nursing, 2006 Feb; 36 (2): 33 (journal article) – PDF attached
15.
Patient Care: Hourly rounds keep call lights quiet
ISSN: 0360-4039 PMID: 16462251 CINAHL AN: 2009121539
-Discussion about the Meade et al (2006) study
Healthcare Risk Management 2007 Sep; 29 (9): 106-7
16.
Patient safety rounds called key strategy
Excerpt from Article:
Patient safety rounds can be an effective way to implement safety initiatives and assess ongoing efforts if
the rounds are done properly, say those who have seen success with the strategy. Weekly rounds by
administrators may not be enough, they say.
Health care providers implement safety rounds in different ways, but many use weekly or biweekly rounds
in which the risk manager, department heads, and other hospital leaders visit various units in the facility
to assess patient safety and get feedback from staff and physicians. That is the method has been
employed for the past year at Holston Valley Medical Center in Kingsport, TN, explains Tony Oliva, MD,
chief medical officer.
Oliva says a main benefit of patient safety rounds is simply having senior leadership out on the
floors where they can be seen and can interact with others. But the strongest results come from
focusing more frequent rounds on key patient safety initiatives, he says.
"We get the best results from having a lot of different people rounding very frequently, sometimes on a
daily basis. ISSN: 1081-6534 CINAHL AN: 2009661074
http://www.highbeam.com/doc/1G1-168098915.html
Okla Nurse. 2006 Dec-2007 Feb;51(4):11. – No abstract available
17.
Hourly rounding for positive patient and staff outcomes: fairy
tale or success story?
Orr N, Tranum K, Kupperschmidt B.
PMID: 17140005 [PubMed - indexed for MEDLINE] ISSN: 0030-1787 PMID: 17140005 CINAHL AN: 2009481048
Am J Nurs. 2006 Sep;106(9):58-70; quiz 70-1.
-Summarizes Meade et al (2006) study
-Discusses procedures, barriers, facilitators, outcomes and a conclusion based on the success story of
one Nurse Manager (Neil) as he partnered with the Medical Surgical Clinical Nurse Specialist (Kristi) and
his staff to implement hourly patient rounding on his Medical Surgical Unit at Hillcrest Medical Center,
Tulsa
-Conclusion: frequent call light use can impose monumental demands on a nurse’s time and energy.
-Multiple interruptions in the cognitive work of nursing can cause omissions in the care and potentiate
medical errors (Potter et al 2005)
-One hour rounding is a care model that effectively decreased call light use and increased
satisfaction among patient population
Page 6 of 8
Bib List: Hourly Rounds
IHI Falls Expedition, Session 5.
Pat Quigley, PhD, ARNP, CRRN, FAAN, FAANP
-Rounding for positive patient and staff outcomes is not a fairy tale; it is a success story waiting
to happen on your unit
Am J Nurs. 2006 Sep;106(9):58-70; quiz 70-1.
18.
Effects of nursing rounds: on patients' call light use,
satisfaction, and safety.
Meade CM, Bursell AL, Ketelsen L.
Alliance for Health Care Research, Studer Group, Gulf Breeze, FL, USA. chris.meade@studergroup.com
Comment in:
Am J Nurs. 2007 Feb;107(2):16.
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.
PMID: 16954767 [PubMed - indexed for MEDLINE]


Using 3 rounding protocols* combined reduced:
22.6% leaving against medical advice
23.4% left without being seen
34.7% call light use
39.5% approaches to nurses station
58.8% falls
Patient satisfaction ratings for overall care & pain management increased significantly.
Advance for Nurses.
19.
Nurses' Answer: Patient Rounds.
Neetzow, C., Miller, S., Kletzing, N., Shelly, S. (2008). Retrieved November 3, 2010, from
http://nursing.advanceweb.com/editorial/content/editorial.aspx?prg=1&cc=105885&CP=1

Measured distance traveled by nursing personnel with a pedometer. Compared before and after initiation of
hourly rounding
It was noted that staff were able to decrease distance traveled by approximately one miles in a 7.5 hour
shift
Noise level was noticeably less due to fewer call bells ringing
Nursing staff became more focused on patient needs and requests. This helped them to know what
supplies would be necessary on the next round.
Qual Saf Health Care 2008; 17: 90-96.
Page 7 of 8
Bib List: Hourly Rounds
IHI Falls Expedition, Session 5.
Pat Quigley, PhD, ARNP, CRRN, FAAN, FAANP
20.
How willing are patients to question healthcare staff on
issues related to the quality and safety of their healthcare? An
exploratory study.
R E Davis, M Koutantji, and C A Vincent.
Surveyed 80 surgical patients
How do you feel about asking certain questions to doctors or nurses?
The questions ranged from simple factual questions like, “How long will I be in the hospital?” to more
challenging questions such as, “Have you washed your hands?'’
The patients were asked to rate their level of willingness to ask the questions on a scale of 1 to 4, with 4
indicating they would be very willing to pose the question to their doctor or nurse.
Basic questions to doctors about length of hospital stay, time off work and details about the procedure
were easy for patients to ask and received high marks (3.4)
But questions aimed at improving patient safety and reducing medical errors were far more difficult for
patients to ask, receiving an average score of just 2.4 points:
o “Who are you, and what is your job?”
o “I don’t think that is the medication I am on. Can you check please?”
o “Have you washed your hands?”
o “How many times have you done this operation?”
However, the survey suggested that if a doctor instructs a surgical patient to be sure and ask about
safety issues like hand washing and medication, patients found it far easier to ask challenging
questions.
For patient safety programs to be effective, doctors and nurses need to communicate to patients that
challenging questions are a good thing.
“Patients need to feel they can ask questions that may be perceived as challenging without causing
offense to those involved in their health care treatment”
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