A visit to a hospital emergency department (ED) can be frightening, overwhelming, and confusing. Helping patients navigate the experience and providing them timely information can improve the patient experience.
More than half of inpatients enter the hospital via the ED and judge their overall hospital experience based on their ED experience. Communication, wait times, and staff compassion are the most commonly identified drivers of the ED patient experience. Along with having their pain controlled, patients in the ED want to be kept informed about their plan of care and any delays. Hourly rounding is an evidence-based practice that effectively addresses these priorities and improves the patient experience.
Surveyed hospitals that had the highest hospital-wide HCAHPS scores reported hourly rounding as a best practice – 83% reported the practice of regular nurse rounding, and 62% employed leadership rounding. One study of hourly rounding in emergency departments documented decreases in: patients who left without being seen (23%); patients who left against medical advice (23%), falls (59%), call light usage (35%), and approaches to the nursing station (40%).
Rounding in the reception area also reduces “left-without-seen” patients. The average emergency department loses at least 2% of patients – those who choose to leave before being treated. This results in lost revenue. Rounding in reception can reduce patient anxiety and increase satisfaction by showing concern for patients, keeping them informed of delays and reassessing their status to ensure clinical safety.
Put in Place a System
One approach is to have leaders round first on staff and patients, modeling the desired behavior and engaging employees. Once leader rounding has taken root, multidisciplinary, jointly led labor/management teams can decide who will regularly conduct the hourly rounding. Organizations may use nurses, clerks, ancillary staff, managers, and others.
Formalized staff training is essential. Those rounding should be trained to address “PPD”(pain, plan of care, and duration/delays) issues. Rounding competency checklists for self-assessment and observer assessment can help to reinforce desired behaviors. These include introduction, explanation of rounding, updating white boards, and assessing the environment to ensure safety.
Once rounding is underway, use a rounding log to record the patient, time, staff, actions, and other notes. Reviewing these data in huddles and other meetings reinforces ownership and helps with continuous improvement. Find a way to display results visually – for instance, create a dashboard that presents measures, opportunities, and financial impact of rounding. The aim is to have all staff be fully committed to rounding and to use a standard practice for its implementation.
An LMP-facilitated process improvement project at Brookdale University Hospital Medical Center has brought labor and management together to identify problems and implement tests for change in the ED. They are moving forward with designing and implementing an hourly rounding initiative. Watch for updates in future Partnership Matters issues!