Proactive patient rounding and effect on patient satisfaction

Effective implementation of nursing staff proactive rounding, a structured method of consistent proactive inquiry and responsiveness to patient needs, has been linked to improved patient satisfaction. Barriers and challenges to proactive rounding processes must be overcome for successful and effective implementation and sustainment to take place. The purpose of this evidence-based quality improvement practice project was to pilot implementation of structured proactive nursing staff hourly rounding and effectively integrate it into current practice to improve patient satisfaction. The project utilized a quasi-experimental nonequivalent group design on a 39-bed medical surgical/telemetry unit to compare top box Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores before and after implementation of a structured proactive rounding process. A total of 59 nursing staff participants took part in the educational sessions. This included clinical care supervisors, RNs, and patient care assistants. Two-sample t-tests performed on HCAHPS top box composites performed on August 2015-August 2016 data (including project month), revealed that the t-statistics were not significant at the .00625 Bonferroni corrected critical alpha level. The differences in top box scores were not significant. A clinically significant increase was noted in the domain "Response of Hospital Staff" from July to August 2016, increasing from 51.7 to 58.9 percent although less than the score reported from August 2015 (61.5 percent). Clinically significant increases in HCAHPS composite top box scores during the three-week timespan of returned surveys were noted in all but three top box scores: Care Transitions reduced from 35.6 to 16.7 percent, Responsiveness of Hospital Staff scores fluctuated between 50 to 100 percent, and Hospital Environment fluctuated between 50 percent and 75 percent. Leader rounding patient satisfaction data revealed clinically significant percentage changes. One-sample t-tests between proportions were performed for each of the leader rounding questions results. The difference between yes responses and no or na/no response answers for each question both before and after the start of the project were significant at the Bonferroni corrected critical alpha level of .007. Two-sample t-tests between proportions were performed on each leader-rounding question to determine whether there was a significant difference between the yes responses for each question both before and after project implementation. The t-statistic was not significant at the Bonferroni corrected critical alpha level of .007. The difference between yes responses were not significant. Clinical significance could be observed through increased positive responses from before project implementation to after in the areas of pain control, staff rounding every hour, staff assisting timely, and whether patients perceived they were getting rest at night. Reductions in responses were noted in the areas of whether caregivers are explaining what they are doing and why, and an increase was noted in the number who had questions regarding their discharge. Communication, understanding, accountability, and engagement are core essentials that can be utilized in the development of processes that contribute to patient satisfaction, including proactive rounding. Process development, implementation, and evaluation are shared actions involving both nursing staff and leaders. Further research should assess sustainability of proactive rounding and competency of the practice through a long-term study utilizing multiple units or multiple sites.