See the opportunities and challenges organizations face in addressing the patient experience. Case Studies provide real stories of current efforts, including programs being initiated, practices being implemented, and outcomes being targeted and/or achieved. Case studies are presented as both an opportunity for learning from others as well as a spark for further ideas on how we work to improve the patient experience. If you have a case study to share please contact us.
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Increasing Patient Safety with a Digital Hourly Rounding Solution
What was the challenge, opportunity or issue faced?
In 2013, Bryan Medical Center, a non-profit tertiary healthcare system based in Lincoln, Nebraska, needed a solution to improve its then paper-based hourly rounding process. Their hourly rounding process was a strategy used to achieve inpatient goals of improving HCAHPS scores and aid in the prevention of patient harm by assuring meaningful contact with staff on an hourly basis.
Administration and nursing leadership recognized purposeful hourly rounding as an essential strategy for proactively managing patient care — helping nurses meet the demands of acute care more effectively. The original implementation of hourly rounding involved documenting on a sheet of paper in the room to keep track of this process at the time of each round. Over time, it became clear that optimizing this strategy to fully yield the intended benefits required improved efficiency and accountability, which was difficult to achieve with a paper-based documentation process.
The current documentation process posed several problems. The paper-based process made it difficult for caregivers to know when an hourly round was due; this posed a major hurdle to consistently completing hourly rounds. Non-digital documentation made compiling and analyzing the paperwork a time-consuming challenge for nurse leaders. Bryan Medical Center needed a solution to enhance the rounding process and drive consistency throughout the organization, giving the opportunity to gain the full-intended benefits that hourly rounding brings to nurses, patients and family.
What did you do to address it?
Bryan Medical Center partnered with Nobl to implement Vigilance™, a digital hourly rounding solution. Bryan Medical Center initially piloted the rounding tool on six adult medical-surgical units. After the pilot phase, the solution was expanded throughout the 640-bed organization and implemented onto 100% of the general acute care, rehab and progressive care areas.
This tool gave the entire patient care team the tools they needed to hardwire the process through an easy-to-use bedside documentation platform. Digital rounding maps displayed throughout the units show patient care staff where they need to be, and when they need to be there. The software integrates with existing technology to ensure nurses can only document an hourly round at the patient’s bedside — creating a safer patient care environment and increasing staff accountability.
The digital tool also gave patients’ families peace of mind with a dedicated Friends and Family Portal for each Nobl Vigilance™ enabled room at Bryan Medical Center. The portal allows family to access 24/7 status updates about their loved one from the comfort of their smartphone or computer — allowing family to monitor their loved one’s health while pursuing their daily life.
What were the outcomes?
Bryan Medical Center has achieved substantial returns from implementation of the rounding tool. In the six (6) months following software implementation on the six adult inpatients units, there was a documented average of 41.4% reduction in patient falls. Staff noted fewer interruptions from call lights and 82.46% of nurses surveyed agreed that Nobl Vigilance™ has improved the consistency of their hourly rounds.
Using Google Analytics™ service, analytics showed that the Friends and Family Portal helped families in all 50 states receive status updates. Further analytics showed that even family outside of the country were using the portal to stay apprised of their loved one’s status. With this portal, there was a decrease in family phone calls to nurses, enabling them to spend more time caring for patients. In addition, families gained insight into their loved one’s activities, allowing families to better schedule time for visitation or phone calls.
Feedback from families using the portal to measure the impact included:
"Great app, I'm in Australia and this enabled me to keep up to date with my Mom's progress without having to call constantly. Thank you so much for having this. It is a great help to families with sick relatives.”
"Love that l could check on my loved one with this, as l am 500 miles from there”
"The Friend and Family portal is great. It was reassuring to read the hourly status without having to bother the nurse. It gave insight to my husband's care. Thank you.”
Implementing a digital hourly rounding solution allowed Bryan Medical Center to enhance process in the following areas:
- Rounding Consistency: Now nurses are able to demonstrate that they meet the hourly rounding requirement during the day shift and every two hours during the night shift, and variance can be tracked by staff member or unit.
- Data Aggregation and Records: Nurse leaders now have the tools to coach staff, discover rounding trends, and recognize the individuals who are providing excellent care, as well as the ability to coach those staff members who may need encouragement.
- Teamwork: The digital rounding maps have allowed staff to visualize who needs to be rounded on — allowing for multidisciplinary care providers to work as a team to care for patients.
- Accountability and Risk Management: Care providers may only access this system in patient rooms, located at the bedside, which creates a dependable and accurate hourly rounding record.
- Patient-Family Centered Care: Family members are able to receive revolutionary quality assurance and peace of mind from hourly updates via The Friends and Family Portal. Families decrease the frequency of calling their loved one’s nurse — ultimately giving the nurse more time for patient care.
- Patient Experience: Patients can reliably anticipate that a care provider will return to their room within the hour to meet their needs — increasing their satisfaction with their care and their care team.
About Bryan Health
Bryan Health is a not-for-profit, Nebraska owned and governed health care organization that cares for patients, educates tomorrow’s health care providers and motivates our community with fitness and health programs. Their award-winning network of doctors, medical centers and medical providers offers effective care; works with industry leaders to introduce leading-edge, proven treatments to our region; and serves rural communities through outreach clinics, mobile services and telemedicine care. They are always focused on providing the personalized care and programs that make a difference in your life.
Nobl is passionate about building leading-edge solutions that improve communication, workflow, and processes for healthcare providers. Their applications combine evidence-based practices with real-time technologies to improve clinical outcomes, enhance the patient experience, and revolutionize the way quality assurance is communicated in healthcare.
Lisa Vail, RN, DNP, NEA-BC, Patient Care Services Vice President/ Chief Nursing Officer, Bryan Medical Center
Marilyn Viehl, RN, BSN, MSN, Nurse Director, Medical Surgical Services, Bryan Medical Center
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