Pilot Studies on Hourly Rounding Every Community

Pilot Studies on Hourly Rounding

Every community has a set of conventions that help govern both how people behave and what beliefs they hold. The conventions that are important to a group (which may also be called the culture of a profession or organization) mean that it can be very difficult to bring about change in the way that individuals act. This is no less true for medical professionals than for any other group; indeed, medical professionals may be even more resistant to change than are others since the consequences of their actions can mean life or death. However, sometimes it is in the best interests of patients (as well as of the medical professionals themselves) that they change the way in which they work.

The most important development in the culture of medicine that has occurred in the last decade is a shift to a greater and greater reliance on evidence-based practice. This requires medical professionals to examine how effective their practices are based not on any intuitive sense of efficacy but on a careful review of actual outcomes. This paper examines the data on one potential shift in nursing practice, which is how rounds are conducted. Rosswrum & Larrabee (1999) note that the essential elements of a shift to evidence-based practice include the fact that medical professionals must remain current on the most recent research.

The authors also write that this shift to evidence-based practice requires a much closer association between clinical practitioners and researchers than has been the case. Academic research has always informed medical practice, but at a remove, with clinicians in general not giving significant credence to research that they considered to be disjoint from the real-world conditions that they face. The subject of this research is an excellent example of the ways in which practice must be informed by research and -- at the same time -- the very high degree of difficulty involved in getting clinicians and researchers to understand that they are in fact on the same team. As Rosswrum & Larrabee (1999) write: "practitioners continue to have difficulty with synthesizing empirical and contextual evidence and with integrating evidence-based changes into practice."

A pilot study to determine how effective a change in rounding practice must be based on the rules of evidence-based practice. The conditions of such a pilot study will be relatively simple to determine, although there are several different research designs that could be implemented that would be equally valid and reliable. One possible research design would be to survey the feelings of both patients and staff vis-a-vis the current (non-hourly) rounding and then after a shift to hourly rounding as well as detailed documentation of the patient outcomes. The fact that the same locale with many of the same professionals and the same basic patient population would be a distinct strength of this research design.

Another, equally valid research design for such a pilot study would be to implement a shift in rounding policy in one setting that is comparable to another in every significant way except that it retains its traditional form of rounding. In this case, patient and staff satisfaction would also be assessed as well as an evaluation of patient outcome.

Before such a pilot program, it will be essential to educate those professionals who are being asked to shift their practice. Providing evidence on the effectiveness on such a shift will reduce the friction that will be produced and will help increase the compliance on the part of the staff. Many members of the staff may (and indeed are likely) to be resistant to such changes. However, given that medical professionals are dedicated to improving patient outcomes, once they are provided with documentation that new rounding procedures are likely to produce better outcomes, they are likely to be more eager to try them.

Previous research has demonstrated that changes in practice can improve patient outcome in a range of different situations. Melnyk (2007) found that the effectives of rapid-response teams are improved by changes in rounding. Baker (2009) also found that even in the most stressful of medical environments (the emergency room) careful attention to the psychological interaction of patients to the frequency of their interactions with medical staff can significantly improve outcome. Increasing the frequency of staff-patient contact (even if that contact involves no more than checking in with the patient) reduces patient stress and increases compliance.

Sidani & Braden (1998) found comparable results. While the nurses in the study tended to assume that patients' sense of well-being and outcome is based on what they saw as "actual" interventions (such as taking blood pressure, etc.) and not simply on contact, which nurses tended to see as time wasting. This was not the case: Patients reported a better sense of control, which is linked in at least some cases to better outcomes, with more and more predictable staff contact.