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Published in CenterView on January 30, 2012
Mary Katherine Brooks, RN on 4C, checks on 1-year-old Darius Calvin during hourly rounds.
Mary Katherine Brooks, RN on 4C, checks on 1-year-old Darius Calvin during hourly rounds.

New initiative brings 'rounding with a purpose' to Children's Hospital

By Jen Hospodor

When the nursing staff at Batson Children's Hospital noticed a slight dip in their perennially above-average patient satisfaction scores, they began looking for ways to turn things around.

They found a solution in a model of patient care called hourly rounding that not only raised patient satisfactions scores, but also decreased call light usage and improved time management for the nursing staff.

"I have long been a believer in the benefits of hourly rounding," said Terri Gillespie, chief nursing officer. "Our patients feel very well cared for and the nursing staff deals with fewer disruptions to their planned work by proactively addressing the needs of the patients and their families."

"There is no doubt that this initiative is working."

Hourly rounding was established in January 2011 on the four inpatient units in Children's Hospital. Prior to this, a reactive approach to patient care existed where nurses were summoned by a patient's call light ring to address a problem.

"We want to get to you before you get to your call light," said Jennifer Stephen, clinical director of emergency services at Children's Hospital. "This is rounding with a purpose instead of putting out fires."

With hourly rounding, nurses or nursing assistants visit each patient's room at least once an hour and address what they refer to as the "4 Ps" - pain, p.o. (a medical abbreviation for "by mouth"), play and parent.

Michelle Palokas, nurse manager, noted that these four areas were identified in research as those most often missed by the nursing staff. So at each visit, the staff asks if the patient is in any pain, needs anything to eat or drink or wants something to play with.

"We also knew it would help with patient satisfaction to make sure that the parent or family member is taken care of as well," she said.

Their efforts paid off. During the four months following implementation of the program, the "likelihood to recommend" scores - considered a key indicator of patient satisfaction - increased and have remained high.

During that same period, nearly 1,400 fewer patient call light rings were reported on the four floors. That averages to approximately 25 fewer call light rings per floor each day.

This dramatic decrease in patients using the call light to summon a nurse is another sign that the program works. The decrease in patient call light usage proved a benefit for nurses and patients alike.

"It actually improves our time management," said Palokas. "The nurses actually take fewer steps in a day because they know they'll be going into the rooms at certain times, so they save tasks for those times and do them all at once instead of making several trips."

Mary Kathryn Brooks, a Children's Hospital nurse, said she likes that the protocol holds her accountable to her patients and has noticed a positive difference in her workday.

"I am able to cluster tasks and do everything at one time and then I can go and chart and I'm ready to get up the next time to go check on my patients," she said. "The patients also learn to ask us for everything that they need when we come in."

Part of a larger national trend, hourly rounding was created by the Studer Group, a company that develops and tests tactics to improve patient satisfaction and safety and then provides hospitals the tools to implement them.