Patient safety rounds called key strategy

Patient safety rounds can be an effective way to implement safety initiatives and assess ongoing efforts if the rounds are done properly, say those who have seen success with the strategy. Weekly rounds by administrators may not be enough, they say.

Health care providers implement safety rounds in different ways, but many use weekly or biweekly rounds in which the risk manager, department heads, and other hospital leaders visit various units in the facility to assess patient safety and get feedback from staff and physicians. That is the method has been employed for the past year at Holston Valley Medical Center in Kingsport, TN, explains Tony Oliva, MD, chief medical officer.

Oliva says a main benefit of patient safety rounds is simply having senior leadership out on the floors where they can be seen and can interact with others. But the strongest results come from focusing more frequent rounds on key patient safety initiatives, he says.

"We get the best results from having a lot of different people rounding very frequently, sometimes on a daily or hourly basis, and not just the weekly administrative rounding process that a lot of hospitals have set as patient safety rounds," he says.

In addition to the standard weekly patient safety rounds with administrators, the system also has used "leader rounding" for seven months and "nurse rounding" for five months. In leader rounding, the clinical leaders from each unit go to patient rooms and check for compliance with fall protocols, ask patients if they understand their medication regimens, and explore similar issues.

That leader rounding happens daily, but nurses conduct more focused rounding on an hourly basis. Every hour, nurses round specifically to assess patients identified at risk of falls, for instance. This rounding is in addition to the nurse's routine rounding for all patients.

"We've found we get more results from those rounds than from the weekly administrative rounds," Oliva says. "They both have their place, but when it comes to real results, the hourly rounds produce much more."

Fall prevention has been a primary patient safety focus for Holston Valley Medical Center, and Oliva says the intensive rounding has yielded a steady decrease. In March 2007, Holston's fall rate was 3.5 per 1,000 patient days and that rate fell to 2.1 in June and below 1 in July.

"We know that the hourly rounding and leader rounding has contributed to this trend," he says. "The reason it works is that you're getting information off the front line. The leader is out there seeing it for himself instead of calling in someone to the office to report what's going on."

University of Michigan reports good results

Patient safety rounds also were established in 2002 at the University of Michigan Medical Center in Ann Arbor to improve patient safety. The rounds have opened a new line of communication between the chief of staff and frontline caregivers. In a recent report on the hospital's experience with safety rounds, the medical center reports that patient safety rounds are biweekly, hourlong meetings between the chief of staff and caregivers on individual patient care units.1

In the past four years (2002-2006), 70 patient safety rounds have been conducted at the University of Michigan Medical Center, and more than 900 area staff members have participated, the hospital reports. Staff attendance averages about nine unit or area staff members per session.

"Patient safety rounds have proven to be a concrete, inexpensive mechanism to enhance patient safety," the report states. "Benefits have been documented in the improvement in the safety culture and development and implementation of preventive strategies to solve patient safety issues."

The Michigan hospital reports that the key components in the success of patient safety rounds are active medical staff leadership and the engagement of physicians and senior management in the process improvements that arise from the rounds.

The team members selected for the administrative patient safety rounds can be key to the success of the effort, says Deborah Morris Nadzam, PhD, RN, FAAN, a nurse and risk management consultant who previously served as executive director of The Quality Institute of the Cleveland Clinic health system. The risk manager or a representative from that department is a natural choice. The CEO or a similar top-level executive also is a great addition to the rounds.

"The presence of the CEO lends credibility to the effort and conveys that this is something the organization takes seriously at the highest level," Nadzam says. "The leader of the quality department also is a good choice because that person often is more familiar to the frontline staff. It's a good idea to always have someone the staff knows participating in the rounding. That can ease anxiety when they see executives coming down the hall."

Including the top-level executives not only sends the right message to the staff, but Nadzam says it produces a more fruitful and robust discussion of safety issues when the board meets. The executives have witnessed the problems themselves and heard from front line staff, instead of relying on information relayed to them. (See article, below, for advice on including employee safety also.)

Going on rounds isn't the final goal, Nadzam says. "You also need to be ready to act on what you find during the rounds," she says. "The rounds are really a data collection process, and then you have to do something with that information, rather than letting yourself think you've done your job by walking around the hospital."

Reference

1. Campbell DA, Thompson M. Patient safety rounds: Description of an inexpensive but important strategy to improve the safety culture. Am J Med Qual 2007; 22:26-33.

Sources

For more information on conducting patient safety rounds, contact:

  • Tony Oliva, MD, Chief Medical Officer, Holston Valley Medical Center, 130 Ravine Road, Kingsport, TN 37660. Telephone: (423) 224-4000.
  • Deborah Morris Nadzam, PhD, RN, FAAN, Joint Commission International, 1515 W. 22nd St., Suite 1300 W, Oak Brook, IL 60532.

Employee safety also good for rounds

Don't forget to include employee safety issues in your rounding strategy, suggests Steve Knowles, safety officer at Women & Infants Hospital of Rhode Island in Providence.

Knowles and other safety officers conduct comprehensive safety rounds at the hospital at least twice a year to look specifically at employee safety and environment of care issues. They check for concerns such as fire doors are not blocked, evacuation plans are posted properly, electrical systems are not overloaded, fall and trip hazards are not present, and food is stored properly. In addition, two members of the safety department participate in weekly rounds with other hospital representatives.

"Each time we go out, we notice a decline in infractions," Knowles says. "Getting out there for the weekly rounds seems to have made a big difference. It shows that the hospital is taking these issues seriously and reminds them that we'll be coming again next week, so we'll spot it again if the problem is not corrected." [Editor's note: Contact Knowles at Women & Infants Hospital of Rhode Island, 101 Dudley St., Providence, RI 02905. Telephone: (401) 274-1100.]