NYC Health + Hospitals, the largest municipal hospital system in the United States, minimized the number of times nurses entered patients’ rooms early in the COVID-19 pandemic.
At the time — when personal protective equipment (PPE) was in short supply and COVID-19 vaccines did not exist — it was a prudent move. Driven by a desire to protect staff and prevent the spread of COVID-19 among hospitalized patients, most facilities limited staff visits to patient rooms. Nurses and other clinical staff members “batched” in-room activities and used phones and video devices to connect with patients.
Nearly two years after COVID-19 emerged, the situation is different: PPE and COVID-19 vaccines are readily available. Unfortunately, the healthcare workforce is still stretched thin. Nearly 1 in 5 healthcare workers have quit their jobs since COVID-19 hit the United States, according to research conducted by Morning Consult. Remaining staff are burnt out – and many (nearly 1/3, according to Morning Consult data) are considering leaving their jobs.
In many places, fewer staff are doing more work. Under those circumstances, it may seem counterintuitive to re-introduce or re-emphasize hourly nurse rounding, but the evidence is clear: hourly nurse rounding can improve clinical outcomes and patient satisfaction.
As early as 2006, researchers and healthcare executives realized that hourly nurse rounding can save time and deliver better clinical outcomes. Data collected from 14 hospitals found that hourly rounding reduced patient calls for assistance to the bathroom by 40%. Patient requests for repositioning dropped 29%; calls related to IV or pump alarms decreased by 40% and patient calls for pain management went down 35% because rounding nurses routinely asked patients about their needs and proactively assisted them.
The Agency for Healthcare Research and Quality also lists hourly rounding as a best practice for fall prevention, noting that hourly visits by nurses significantly reduces fall rates, particularly for older adults. A 2016 study published in JBI Database of Systematic Reviews and Implementation found that hourly rounding decreased patient falls by 50%.
NYC Health + Hospitals installed windows in some patient room doors and used video devices to maintain line of sight during the pandemic, and intend to continue and expand those efforts, according to a recent editorial in JAMA Internal Medicine. The editorial authors (three physicians) write that “video monitoring may prevent falls, a chronic problem in hospitals, by alerting nurses that patients are getting out of bed.”
The utility to this approach is debatable. In the time it takes to notify a nurse that a patient is getting out of bed, the patient may have already fallen. Hourly in-person rounding prevents falls because it enables nurses to meet patients’ needs — companionship, a trip to the restroom, pain control — before the issue becomes so urgent that the patient gets out of bed in an attempt to independently meet that need.
Similarly, in-person rounding can effectively prevent bedsores because staff can physically reposition patients. In-person visits also alleviate patient anxiety. As noted in a NEJM Catalyst article, “When faced with a wait without an explanation, the brain will create a narrative. And for patients, it may be ‘they don’t care about me’ or ‘they forgot I was even here.’”
Regular visits reassure patients.
Of course, it is unreasonable to expect short-staffed, stressed-out nurses to visit each patient’s room hourly without addressing the fact that most nurses already feel overworked. To effectively institute hourly rounds, you must first assess and address workflow.
A 2018 time motion study found that nurses spent 10% of their time on delegable and non-nursing activities. Assessing the movement of healthcare providers and ancillary staff in and out of patient rooms can help managers identify patterns of activity and opportunities for change.
Clean Hands – Safe Hands electronic hand hygiene system can pinpoint which providers are visiting rooms more frequently (and less frequently) than usual, allowing managers to investigate and address workflow inefficiencies that may be impacting clinicians’ activity. At one hospital, for instance, data revealed that clinicians were frequently in and out of patient rooms near the supply closet. Moving linens into patient rooms streamlined clinician workflow and allowed them to spend more meaningful time with patients.
Regular contact with patients is key to excellent clinical care, as well as patient and provider satisfaction. Healthcare executives looking to boost outcomes and satisfaction would do well to re-emphasize hourly rounding.