Nurse leader rounding has been associated with improved ratings from patients regarding their care experience in hospital inpatient and emergency departments1. It has also been shown to improve the quality and safety of care2. But the traditional approach to nurse leader rounding, using pen and paper to document information, is time consuming and inefficient. More importantly, from a patient care standpoint, it fails to deliver real-time data on patients’ health.
The experience of Carroll Hospital with a digital inpatient rounding solution shows that there is a better way to do nurse leader rounding.
Carroll Hospital is a 179-bed acute care hospital in Westminster, Maryland. Since 2015, the hospital has been part of LifeBridge Health, which includes three acute-care hospitals, a geriatric facility, and numerous outpatient clinics in the greater Baltimore area. Carroll Hospital had 13,791 inpatient admissions and outpatient observation episodes and 52,371 emergency department visits in 2016.
Until recently, our hospital’s nurse leader rounding program was beset by the typical inefficiencies of manual approaches, including the following:
- An inability to customize patient questions and use cases;
- rounds that took too long to complete;
- workflow interrupted by the constant collection and distribution of data.
The hospital decided to implement automated rounding technology with the goals of putting patients first, decreasing labor and time associated with data collection and distribution, validating rounding compliance, and improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.
The digital nurse-leader-rounding solution we chose, GetWell Rounds+ (formerly known as Marbella), can be used on a tablet at the bedside. It is accessible from any mobile or desktop device or patient kiosk and is integrated with our electronic health record (EHR) system. The hardwiring of nurse leader rounds greatly reduces the amount of time that nurses have to spend documenting their patient encounters. And, because the data is available immediately in the EHR, clinical teams can keep a closer eye on their patients.
The digital system supported nursing units to individually prioritize their improvement opportunities and questions specific to each unit.
The use cases for the rounding solution include checklists, audits, surveys, reporting, trending, and benchmarking. It can also be used to send real-time text and email alerts for prioritized response and service recovery. Finally, it is a management tool that supervisors can use to see which staff members rounded during particular shifts, and to compare performance among nursing units.
In February 2017, the hospital went live with the digital nurse leader rounding solution. Within four months, the HCAHPS scores had shown a significant increase. For example, the HCAHPS survey question “Overall Rating of the Hospital,” improved from 61.0 to 76.5. Other areas of HCAHPS improvement included the following:
- Discharge instructions: 82.8 to 86.8
- Communication with doctors: 72.3 to 77.8
- Doctors listened carefully: 71.3 to 77.8
- Doctors treated with courtesy/respect: 71.3 to 86.9
- Communication with nurses: 76.8 to 81.9
- Nurses listened carefully: 73.2 to 77.8
- Staff talked about help when you leave the hospital: 83.6 to 89.5
- Information re: signs and symptoms to look for: 82.1 to 84.2
- Staff help with pain: 69.7 to 78.6
These HCAHPS scores showed us that the digital nurse leader rounding solution helped improve our patients’ experience and perception of their care during their stay at Carroll Hospital. To further improve the experience and quality of care, we are using defined, standard nurse leader rounding questions to obtain patient and family feedback to identify improvements. Carroll Hospital now has the ability to better listen to our patients for opportunities as well as document, trend, and share rounding results and comments.
References
- Judy C. Morton, Jodi Brekhus, Megan Reynolds, and Anna Kay Dukes, “Improving the patient experience through nurse leader rounds,” Patient Experience Journal: Vol. 1, Issue 2, Article 10.
- Baker S. Rounding for outcomes: an evidence-based tool to improve nursing retention, patient safety and quality of care. Journal of Emergency Nursing. 2010;36: 162-4.
