Rounding is a critical hospital function aimed at improving patient safety and quality of care. However, more often than not the process of rounding can be inefficient for nursing and ancillary staff, consuming time and resources that they could spend elsewhere.
A nurse's presence in the patient's room can greatly improve care. However, if the rounding process is inefficient and ineffective, staff and patients will be dissatisfied. Patient-centered care relies upon the ability of staff to listen to the patient's needs and carefully evaluate and respond.
A recent webinar hosted by Becker's Hospital Review and presented by CipherHealth discussed how to boost both staff and patient satisfaction by improving rounding processes through technology. Improving staff members’ perception of rounding has the potential to improve patient outcomes and drive towards a more patient-centered care model.
The panel included Doug McPherson, CipherHealth's director of accounts, who discussed how digital rounding could help a hospital implement patient-centered care. He was joined by Jenny Snodgrass, the IT System Team Coordinator for Sentara Healthcare, and Berlinda E. Bowdwin, RN, a clinical nurse manager at Sentara Princess Anne Healthcare.
Mr. McPherson said patient-centered care has been an oscillating focus in healthcare but is now reemerging as a topic of discussion in boosting positive patient outcomes, especially as the healthcare industry transitions to a value-based reimbursement model.
"We talk about patient-centered care as if it were a new concept, but it's a really basic thing," Mr. McPherson said. "Clinicians become clinicians to help patients. It's a patient-centric idea to begin with.”
Patient-centered care relies upon effective communication, empathy, and a feeling of partnership between clinician and patient to improve patient outcomes and satisfaction, to manage symptoms, and to reduce unnecessary cost, Mr. McPherson said. Patient-centered care has been shown in multiple studies to improve patient outcomes, which has been linked to reduced costs because of fewer readmissions and care expenses, he said.
"The challenge behind these studies is to shift our thoughts from 'What's the matter with our patients?' to 'What matters to our patients?'" Mr. McPherson said, quoting Dr. James Rickert.
New York City-based CipherHealth provides a digital rounding tool called Orchid to Sentara Healthcare, a 126-year-old health system based in Norfolk, Va., that operates 12 acute care hospitals and five medical groups across Virginia and one hospital in North Carolina. Orchid makes rounding paperless through an app available for smartphones and tablets, providing an issue resolution system to enhance communication between nurses, staff, patients, and physicians across the hospital.
Ms. Snodgrass, who oversaw the effort to implement Orchid, said the main goal of implementing the technology was to add time to the nurses' day by simplifying tasks and streamlining workflows, and thus, improving the patient experience. The implementation of Orchid also fit in with Sentara’s priority of achieving the triple aim.
"Sentara is dedicated to accomplishing the triple aim: improving the health of populations, improving the patient experience, and reducing the per capita cost of healthcare, all in order to optimize our health system's performance," Ms. Snodgrass said. "However, there is one thing missing: staff satisfaction."
She said providing the platform to facilitate better communication among the staff enhances satisfaction, and ease-of-use empowers users to utilize the tool to its full potential. Sentara began implementation in December 2013 and launched three months later in two facilities. The health system is currently implementing Orchid in additional departments, including the ED, and will implement the system at its 10th and 11th facilities in May and June of this year, she said.
Ms. Snodgrass said the adoption of Orchid expanded on a partnership Sentara began with CipherHealth in 2012 when they worked together to improve the patient experience and reduce readmissions through post-discharge follow up to patients.
Most importantly, she said digital rounding fits into nurses' workflows so they do not have to carve out a place for it in their day. For Sentara the utilization of a digital tool meant ensuring its staff could get the most out of each rounding experience and drive improvements across the system.
Ms. Bowdwin spoke to the cultural shift that takes place when staff grows more content with hospital processes. When staff burnout affects many hospitals across the country, it is important to gain buy-in and make sure each new initiative has a positive impact on those who spend the most time with patients.
"The impact of digital rounding has changed the culture of the hospital," Ms. Bowdwin said. "As a nurse manager rounds, they become a quarterback for issue resolution, including issues that are experience-related. The nurse manager is empowered to make decisions, resolve issues quickly and on the spot."
After the system was implemented, Sentara sent around a survey to gauge how the nursing staff felt about the digital rounding tool. The responses showed a great improvement in the way staff members felt about rounding: nurses felt that they were 56 percent more effective in resolving issues and 55 percent more satisfied with the rounding process, Ms. Bowdwin said.
The culture shift has caused what Ms. Bowdwin calls "the round before the round." Essentially, unit nurses inspect rooms before the nurse mangers go on their rounds to ensure everything is tip top. The entire staff is more engaged and constantly striving for perfection, Mr. McPherson explained.
Patients have also shown satisfaction with the digital rounding platform: they experience effective and timely issue resolution, feel that someone is listening to their needs, perceive higher control over care, and have a safer stay, as evidenced in a bump in HCAHPS scores. Nurses can identify any gaps in protocol during their rounding process. The results have immediate impact on patient care as one of Sentara's facilities experienced a month with zero patient falls after implementing Orchid, Ms. Bowdwin said.
To monitor compliance, Sentara implemented a partnering system between Ms. Snodgrass and a group of site leaders. The tool also allows chief nursing officers to check rounding activity down to unit level, ensuring compliance and effective use of the technology, Ms. Snodgrass said.
Ms. Bowdwin emphasized how the technology allows nurses to more carefully focus on patients. Although nurses bring an iPad with them, it has not had a negative effect on patient engagement, she said. Instead, it allows patients to see what is being documented and have an active role in their medical record.
"I think the most important thing is to find out what matters to the patient, to convey empathy and caring and actively listen through the rounds to make sure that the patient knows you are listening and will be acting on the information they are providing to you," Ms. Bowdwin said. "If your focus is on the patient, the staff will focus on the patient. The relationship we have with the patient is that we're trying to foster a trusting and caring relationship between the patient and the provider."
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