Hourly Rounding in the Emergency Department and …studergroupmedia.com/WRIHC/presentations/hourly_rounding_in_the... · 1 © 2008 Studer Group Hourly Rounding in the Emergency Department

1 © 2008 Studer Groupwww.studergroup.com

Hourly Rounding in the Emergency Department and Inpatient Areas

Becky Montesino, RN, BSN, MSVice President/Chief Nursing Officer

Baptist Hospital, Miami, Florida

What’s Right in Health CareSM | Evidence to Outcomes

Presentation Objectives

• Describe the art and science of “hourly rounding”– Purpose– Process

• List expected outcomes of “hourly rounding”– Inpatient results– Emergency Department results

• Identify the return on investment potential from hourly rounding




You are not alone

•WE ARE JUST LIKE YOU.

•WE HAVE THE SAME

CHALLENGES.



WELCOME TO BAPTIST


Hourly Rounding

• A REPETITIVE PATIENT CENTERED ACTIVITY FOR SAFETY, COMFORT, PATIENT SATISFACTION AND EVERYONE’S PEACE OF MIND.

• WITH THESE GOALS IN MIND,WHO WOULDN’T WANT TO ROUND?

• WE HAD GREAT OUTCOMES AND A VISIBLE ROI.



Introduction to Leadership

• HEY, EVERYONE, OUR RESULTS ARE NOT SO GOOD! (IP=74; ED=4)

• HERE IS WHERE WE NEED TO BE…(IP=90, ED=50)

• HERE IS WHY…(HINT: PATIENT)

• AND…HERE IS HOW WE ARE GOING TO DO IT!


Leadership Development

• ROUNDING IS AN ART

• ROUNDING IS FOR A PURPOSE AND• HAS OUTCOMES ASSOCIATED WITH

IT

• ROUNDING EDUCATION IS A MUST

• SCRIPTING



Rounding Tools

• ROUNDING LOGS

• WHITE BOARDS

• ROUNDING ON ROUNDING

• REWARDS AND RECOGNITION


Accountability

• THIS IS THE HARD PART

• IT STARTS AT THE TOP

• YOU NEED THE RIGHT PEOPLE ON THE BUS

• YOU CAN’T LET UP



Service

• Weekly Accountability Tool

• Contains Leader’s Names

BAPTIST HOSPITAL OF MIAMIPatient Satisfaction Report

How to Use this Report Please post these results on the communications board in your unit under the SERVICE pillar by Friday. Carry a copy of this report with you at all times so you can communicate results while rounding with staff and during staff meetings.

Our goal is the 90th percentile for all areas.

Quarter-to-date ending on: Feb. 23 Mar. 1 # of

surveys returned

Inpatient 96 93 789 Emergency (Adult) 30 33 617 Outpatient Surgery 77 76 158 Outpatient Services 94 91 426

1 East Lake - M. Guignard 99 99 25 2 Tower – J. Maloney 90 80 62 3 Tower - M. Suarez-Cantillo 63 59 72 4 Tower - L.Lorenzo 11 19 62 5 Tower - C. Bowling 99 99 38 3 Main - M. Guignard 95 95 68 4 Main - R. Cordo 59 79 32 5 Main - S. Ocon 99 81 26 Rehab - E. Matalon 96 98 13 Women’s Srvc - M. Perez 99 99 59 4 BCVI - D. Thomas 99 99 82 OB - B. Roberts, M. Perez 92 90 124 Peds/PICU - L. McCarthy 99 99 85 NICU - M. Olmeda 37 70 12 Short Stay - R. Maluf-Contreras 99 99 50 ICU - B. Stolzenberg 90 90 132

Admissions 72 67 779 Rooms 97 94 788

Meals 98 97 772 Nurses 93 91 789

Tests and Treatments 93 93 759 Visitors and Family 85 73 768

Physicians 84 82 782 Hospitalists - Dr. Villanueva 96 94 84

Discharge 94 94 774 Personal Issues 96 95 776 Emergency Department

ER Peds - M. Decady-Alexis 89 90 300 Arrival 85 85 299 Nurses 91 92 298

Physicians 83 87 298 Tests 87 89 190

Personal Issues 91 91 295 ER Adult - M. Rafuls and 30 33 617 S. Balbosa-Saunders Arrival 15 14 612

Nurses 28 33 608 Physicians 52 57 607

Tests 35 40 551 Personal Issues 32 36 608

Outpatient Services

Quarter-to-date ending on: Feb. 23 Mar. 1 # of

surveys returned

Urology Lab - S. Callis 99 32 11 Radiation Therapy - G. Weiss 99 99 25 Sleep Center - A. Vinent 91 72 31 Nuclear Medicine - S. Bracci 99 93 46 PET - S. Bracci 93 98 37 Pulmonary - A. Vinent 99 99 24

BCVI - J. Kiah & D. Rodríguez 92 92 340

Endoscopy - D. Phillips 99 99 23 Ultrasound - S. Bracci 99 99 58 CT - S. Callis 4 8 27 Oncology - C. Bowling 99 99 10 Plain films/Flouro - S. Callis 73 89 31 EEG - S. Holan 99 99 7 OP Ortho Rehab - C. Larco 56 46 38 OP Neuro Rehab - R. Mojica 52 48 40

Registration 73 67 413 Facility 89 86 420

Test and Treatments 98 97 423 Personal Issues 89 84 413

Registration Areas

IP/OP Registration - K. Folkman 75 72 1051

OPS/BCVI Registration - M. Sousa 80 84 536

ED Registration - M. Basden 71 69 885

HCAHPS Overall Rating 78 77 100

Would you recommend 86 86 99 HCAHPS Results are % of Top Box Responses

Priority Index Focus

Quarter-to-date:

Inpa

tient

Out

patie

nt

Surg

ery

Out

patie

nt

Serv

ices

Emer

genc

y

Response to concerns and complaints 94 65 74 n/a


Inpatient Rounding

• ROLL-OUT ON PATIENT CARE CENTERS (“You want me to do what???”)

• BUY-IN FROM STAFF (“I won’t do it.”) (“I can’t possibly have time.”)

• CHALLENGES…

• REMEMBER THAT OUR GOAL WAS TO IMPROVE PATIENT SATISFACTION



ED Rounding

• “YOU HAVE GOT TO BE KIDDING. OUR NURSES ARE NOT GOING TO DO THAT.”

• SOME OF THEM DIDN’T.• THEY WEREN’T ON THE RIGHT BUS.

• THE NURSE MANAGERS HAD TO LEAD THIS AND ONCE THEY DECIDED TO DRIVE THE BUS, WE WERE ON OUR WAY.


What does rounding look like?

• Insert rounding checklist photo




What does ED Rounding look like?

• Insert photo of white board









What does Rounding look like?

• Insert white board photo


WHAT DOES ED ROUNDING LOOK LIKE?

• Insert photo of me checking logs



Linking Outcomes and ROI

• WE STARTED OUR HOURLY ROUNDING ADVENTURE WITH THE INTENTION OF IMPROVING PATIENT SATSFACTION.

• WE HAVE REALIZED THERE IS A RETURN ON OUR INVESTMENT IN HOURLY ROUNDING BEYOND IMPROVED PATIENT SATISFACTION SCORES.


Service - Patient Satisfaction Percentile Ranking

0102030405060708090

100

Q1 FY07 Q2 FY07 Q3 FY07 Q4 FY07 Q1 FY08 Q2 FY08

Perc

entil

e R

ank

Inpatient Ambulatory Surgery Outpatient Services

90th Percentile



Other Miami Dade ComparisonJuly 2006 - June 2007Published March 21, 2008 on www.hospitalcompare.hhs.gov

National Average: 63%

*OTHER MIAMI DADE HOSPITALS DATA NOT AVAILABLE: DOUGLAS GARDENS HOSPITAL, LARKIN COMMUNITY HOSPITAL, PALM SPRINGS GENERAL HOSPITAL, WESTCHESTER HOSPITAL


Adult Emergency Department April Satisfaction Scores

11%

7%

14%

28%

41%

VPPFGVG

VG

P

VP

F

G

APRIL WAS ATTHE 2nd PERCENTILE



Adult Emergency Department August Satisfaction Scores

3% 3%9%

30%55%

VPPFGVG

VG

F

G

AUGUST IS ATTHE 79th PERCENTILE


4 5

30

10 12

2 210 11

42

79

0

10

20

30

40

50

60

70

80

90

100

Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07

Perc

entil

e R

ank

Hourly Rounding

Goal FY07

Goal FY08

Goal FY09

Service - Adult ED Satisfaction Score October 2006 to August 2007



PeopleNDNQI RN Survey Job Enjoyment Scale T-ScoreBaptist Hospital All Units Average

4042444648505254565860

2005 2006 2007

T-Sc

ore:

<4

0 lo

w s

atis

fact

ion;

40-

60 m

od. S

atis

fact

ion

>6

0 hi

gh s

atis

fact

ion

Top Quartile 60


Service – Medical Staff Satisfaction

• Overall Satisfaction 94th percentile up from 74th percentile

• Satisfaction with Nursing 89th percentile from 57th percentile

• Would you recommend to friends/family 96th percentile

• Collaborate discussions around the Pillars.• You have service and quality in common.



Patient Falls/ADJ Admission

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

2002 2003 2004 2005 2006 2007 2008 Q1

Hourly Rounding Initiated

Patie

nt F

alls

per

Adj

uste

d A

dmis

sion

s

N=113


Falls with Significant Injury

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

2002 2003 2004 2005 2006 2007 2008 Q1

Sign

ifica

nt In

jurie

s %

Tot

al

Falls

N=2




$55,000.Increased care (1)needs

$400,000. Bilateral Tib-fib (1)

$50,000.$55,500.$165,000.Shoulder (3)

$465,000.$651,250.$2,605,000.Head/brain (4)

$100,000.$135,000.$675,000.Hip (5)

MedianMeanTotal2002-present

Falls = $3.9 Million (Settlement value only)


0

0.25

0.5

0.75

1

1.25

1.5

2003 2004 2005 2006 2007 2008Q1

Total reports

Hospital acquired

Pressure Ulcer % of Adjusted Admissions




Decubitus Ulcers (Settlement value only)

$158,125.$1,265,000.Decubitus (8)Ulcers

MeanTotal2002- present


0

10

20

30

40

50

60

2 0 0 5 2 0 0 6Q2

2 0 0 6Q4

2 0 0 7Q2

2 0 0 7Q4

Letters of Intent and Open Law Suits(Average number open claims)



Good News

• WE HAVE JUST BEEN INFORMED THAT OUR INSURER HAS REDUCED THE AMOUNT OF INSURANCE WE

ARE REQUIRED TO CARRY BY SEVERAL MILLION DOLLARS.


ED Lobby Rounding

• WE WANTED TO REDUCE LWBS.• IT MEANT WE WOULD NEED TO

ROUND IN THE LOBBY.• HOW DO YOU DO THAT?• INTRODUCING HUDDLE ROUNDS.• REQUIRING ROUNDING LOGS.• ASSIGNING HOURLY ROUNDS.

• IT WORKS!!



Service

400

500

600

700

800

900

1000

1100

FY06 Q1 FY06 Q2 FY06 Q3 FY06 Q4 FY07 Q1 FY07 Q2 FY07 Q3 FY07 Q4

Min

utes

0

2

4

6

8

10

12

14

16

Percent

Goal #2 Reduce Emergency Department LWBT

Goal = 5.5%


ROI - Emergency DepartmentHourly Rounding

ED Annual VolumeAverage Patient RevenueBeginningCurrentROI

57,500$4748.4%5.0%

$926,670






Finance – Hospital Margin

7.7%

3.3%2.3%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

'07 Actual '07 Budget '06 Actual




Growth

Thank You!

Becky Montesino, RN, BSN, MSVP/CNO, Baptist Hospital, Miami, FL

Documents

Hourly Rounding in the Emergency Department and …studergroupmedia.com/WRIHC/presentations/hourly_rounding_in_the... · 1 © 2008 Studer Group Hourly Rounding in the Emergency Department