I just ran across this study from the Agency for Healthcare Research and Quality (AHRQ) that is a massive reinforcement of common sense. Let me ask your opinion …
Which do you think would produce better hospital outcomes and patient satisfaction.
a) If the nurse waits for patients to push the call button and then takes care of their specific issue?
b) If the nurses round regularly, checking in on patients whether they push the call button or not and that this is a routine expectation for the performance of their job?
You got it. (b) wins.
IN FACT … this one change took Patient satisfaction ratings from 50-60% up to 99%.
A stunning change in the way the patients viewed the quality of their care.
When nurses round “regularly during the day shift and every 2 hours at night” … here’s what happens (and it is a truly stunning improvement in quality of care):
- Fewer calls: The number of call lights fell by 65 percent on Northeastern’s medical-surgical unit (actual data are not available).1 Anecdotal feedback reveals that call lights blinked constantly prior to program implementation, but now they light up very rarely. Most calls now come from patients with truly important needs or from newly admitted patients (who quickly stop using the call lights once they learn the routine). While nursing staff had previously become desensitized to the call lights because of their frequency, they now answer them very promptly, as they know they have been activated for a meaningful need.
- Fewer falls: Falls have been reduced by roughly 65 percent since hospital-wide implementation of the rounding program, reaching 3.0 per 1,000 patients by the end of 2008.
- Elimination of pressure ulcers and skin breakdown: After implementation of rounding, the incidence of hospital-acquired ulcers and skin breakdown fell to zero and remained there through 2008 (incidence rates prior to implementation are not available).
- Anecdotal reports of fewer medication errors and IV complications: While no hard data are available, the nurse manager reports a significant decline in medication errors, likely because nurses are less distracted by call lights. The manager also reports fewer IV complications (e.g., IV infiltration due to a dislodged IV, collapsed vein, etc.), largely because staff check IV lines during each rounding visit and address any swelling, redness, pain, or other early signs of complications immediately.
- Higher patient and staff satisfaction: The percentage of patients rating patient care as “excellent” increased from the 50-60 percent range before program implementation to 99 percent afterwards. These high rates have been maintained through 2008. Anecdotal reports suggest that nurses and certified nursing assistants are highly satisfied with the rounding system; at weekly meetings, nursing staff members report fewer interruptions and more time for activities such as patient education and better documentation.
- Lower overtime costs: The nurse manager reports that overtime costs have declined considerably since implementing the rounding process as a result of better time management on the part of the nursing staff (no data available).
I am always a little shocked that studies like this really have to be performed. At the same time I am relieved that if anyone needs “evidence” for a policy like this in the hospital … well, now they have it.