By Paul T. Gallese, PT, MBA
Hospital patients depend on their care team to make sure they get well – it’s that simple. Part of that healing process includes purposeful rounding – “a proactive, systematic, nurse-driven, evidence-based intervention that helps (us) anticipate and address patient needs,” according to “The Value of Purposeful Rounding,” an article in American Nurse Today, the official journal of the American Nurses Association (McLeod & Tatzlaff, 2015).
All of us, in some scenario for ourselves or a loved one, have experienced a nurse coming into the hospital room and asking specific questions. The regularity of those check-ins may go unnoticed by patients, as they focus on their paths to better health. Yet, nurses consider purposeful rounding a regular and valuable part of their caregiving process, one that demands ample time to interact with all patients and fulfill their individual needs.
This post reviews the benefits of purposeful rounding and also explores how automated monitoring technology can improve the efficacy of rounding and enhance patient safety.
Purposeful rounding decreases patient anxiety. Decreasing anxiety among patients often results from purposeful rounding. When receiving regular visits from a nurse, patients recognize that nurses are available to help them with whatever need they might have – whether it is getting out of bed to visit the bathroom or asking for pain medication. Checking on hospitalized patients (in what’s now known as rounding) has been part of the nursing curricula since the mid-1970s, with the practice name and approach evolving over the decades, as noted in “Hourly Rounding to Improve Nursing Responsiveness: A Systematic Review” (Mitchell et al, 2014) from the Journal of Nursing Administration.
Purposeful rounding increases quality of care and patient satisfaction. Increasing the quality of care and patient satisfaction matters from a financial perspective, with reimbursements shifting from fee-for-service to fee-for-value – or value-based care. Purposeful nurse rounding contributes to improvements in patient care and satisfaction, as noted in “Purposeful and Timely Nursing Rounds: A Best Practice Implementation Project” (Daniels, 2016). “Nurses have the ability to improve patient satisfaction and patient safety outcomes by utilizing nurse round interventions which serve to improve patient communication and staff responsiveness,” the authors state. In addition, nurses are trained to address the 4 Ps of patient care during purposeful rounding: potty (use of the bathroom), positioning, pain control and proximity of personal items (Blakely et al, 2011). Patients depend on these interactions with nurses, and purposeful rounding helps care providers to perform these aspects of patient care to the satisfaction of patients.
Purposeful rounding can reduce readmission rates. Research on responsiveness to patients and its effect on 30-day readmission rates (Yang et al, 2018) “suggests that elements of care related to staff responsiveness during patients’ stay may influence re-hospitalization rates. Changes in staff responsiveness may offer an additional tool for hospitals to employ to achieve reductions in readmissions, as these researchers report.” Thus, nurses following purposeful rounding procedures and responding to individual patient care needs can only improve the satisfaction that patients experience during their hospital stay.
Addressing barriers to purposeful rounding
Despite the positive outcomes achieved by purposeful rounding, barriers exist to implementation. Common barriers include buy-in, acuity levels, time management and unexpected interruptions (Shepard, 2013). You can read more about these barriers in How to Implement Nurse Rounding in Hospitals, a Vitalacy blog post by Lauretta Ihonor (2018).
A common component appears, in my opinion, in each of these four barriers: time. How many minutes in a shift does a nurse have for purposeful rounding and what is the best use of time for those minutes? Assessing the level of care patients need varies each day and each shift, as the status of patients changes. And, of course, new priorities always surface, representing another demand on nurses’ time. Dilemmas in Healthcare: Nurse Shift Fatigue, a Vitalacy blog post by David Weinstein (2019), highlights the stress and fatigue experienced by nurses.
The Benefits of Automated Purposeful Rounding
Automated purposeful rounding can provide additional favorable patient outcomes. Here are three ways automated purposeful rounding benefits both the patient and the healthcare provider:
Data collection to track and improve outcomes. Healthcare depends on data to track and improve outcomes. For example, Mitchell et al, 2014, reviewed 16 published articles on purposeful rounding. Their article states that “automated data collection, which is often used to measure call light usage, allows for more complete collection of data and reduces risk of bias” compared to methods that collect data only during certain timeframes (for example, the last week of the month) when nurses know their performance is being monitored.
Workflow monitoring. Vitalacy’s purposeful rounding data solution tracks which staff member completed rounding in each room, at what time, and for how long, as noted in the Vitalacy white paper, “Finding New Ways to Prevent Healthcare-Acquired Infections and Conditions” (2019). This data-driven solution helps managers know which patients have not been visited as needed and helps identify high- and low-performing staff to target education and training. The timing and frequency of visits can be set for each patient and adjusted to alert for higher-risk patients.
Performance feedback. Automated systems provided feedback to care providers on measures such as the quality of hand washing and hygiene. This feedback helps providers to self-improve and provides data to spur better team performance (Vitalacy 2019).
An Automated Solution from Vitalacy
Vitalacy developed its automated nursing rounding data solution after a nurse manager suggested adapting technology used for Vitalacy’s automated hand hygiene compliance tracking solution as a way to track and improve the rounding activities of her staff, especially for late-stage cancer patients. Her suggestion rose from a concern about the high fall rate at the medical center due to severely immunocompromised end-stage cancer patients at high risk for falls and other complications. Discover more on Vitalacy's staff rounding solution at www.vitalacy.com.
McLeod J & Tatzlaff S. The value of purposeful rounding. American Nurse Today, 2015;10(11).
Mitchell, M. D., Lavenberg, J. G., Trotta, R. L., & Umscheid, C. A. Hourly rounding to improve nursing responsiveness: a systematic review. The Journal of Nursing Administration, 2014;44(9):462–472. doi:10.1097/NNA.0000000000000101
Daniels JF. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI Database System Rev Implement Rep. Jan. 2016;14(1):248-67. doi: 10.11124/jbisrir-2016-2537. PubMed PMID: 26878929.
Blakely, Donn, et al. The impact of nurse rounding on patient satisfaction in a medical-surgical hospital unit. MedSurg Nursing, Nov.- Dec. 2011, p. 327+.
Yang, L., Liu, C., Huang, C., & Mukamel, D. B. Patients' perceptions of interactions with hospital staff are associated with hospital readmissions: a national survey of 4535 hospitals. BMC Health Services Research, 2018;18(1),50. doi:10.1186/s12913-018-2848-9
Shepard, Leslee H. EdD, MSN, RN, CMSRN. Stop going in circles! Break the barriers to hourly rounding. Nursing Management (Springhouse). Feb. 2013;44(2):13-15. doi: 10.1097/01.NUMA.0000426147.98903.ae. Department: Team Concepts
Ihonor, L. How to effectively implement nurse rounding in hospitals. Vitalacy Blog. Dec. 2018.
Weinstein, D. Dilemmas in healthcare: nurse shift fatigue. Vitalacy Blog. March 2019.
Vitalacy, Inc. Finding new ways to prevent healthcare-acquired infections and conditions. 2019.