Hourly Rounding in the ED

Specialties Emergency

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The ED I work in has instituted a "policy" of hourly rounding. I understand that this is an ideal on a medical/surgical type floor and agree with the concept in the ED but......am wondering about in the ED. Do any of you work where hourly rounding in the ED is the norm. I make a point of checking my patients frequently (usually more often that q hour) and charting the interaction. Part of this new policy is an effort to improve our patient satisfaction scores. A second suggestion that is floating around is doing walking rounds at change of shift. Again I see the value but am wondering about how well it works in the ED. Any thoughts? What is your ED's policy on charting and patient rounds.

It is the shape of things to come

My ER wouldn't consider this , well I at least hope not. They are big on time managment. Our ER runs pretty smoothly and our press ganey scores are pretty good. The tales often posted in here sometimes seem very foreign as compared to how ours is run. We're fully staffed, the moral and teamwork is really good and management likes to keep us happy. Management gets in there to help too. Sure, customer service is always right up there in wants and needs. I think what helps is the fact that all of our manangement were out in the trenches at one time. Our hospital is in theTop #100 hospitals in the nation since the concept of the award. I am really lucky to work where I do. There's a waiting list to work in our ER. The casual people are begging for time. If there was one thing that puts a wrench in the whole program is the non-emergent entitlement mentality that come through the doors. We handle that the best we can and management supports our efforts. We have a shared decision making committee that meets every 3rd week and we brainstorm for better service and teamwork approach. We essentially round every two hours anyway as we have to revital/assess pain at least every 2 hours, but we do not have a "team" that does it....it's the nurse who is taking care of that patient's responsibility.

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Specializes in ER.

Our ER recently started hourly rounding in order to increase patient satisfaction. One of the main complaints patients and their families have is that "no one has been in", we all know this is usually untrue but it is their perception. It does not have to be the patient's primary nurse, it can be a paramedic or Charge nurse or another nurse, as long as someone checks on the patient and their comfort and give them some idea of a rough time frame. It is hard for us to remember that although time is flying by for us (because of the million things we need to do for the other patients) the patient and their family have nothing better to do than sit and watch the clock. It is really hard when you are on the other end of things. I think if everyone is on-board and helping it is do-able but is unrealistic for one person to do, all the time.

The other new thing is bedside reporting in the ER. I understand why the director wants to do this ( this way the patient gets introduced to the oncoming shift and gets and idea of what they are waiting for, etc) but you CAN NOT always give bedside reports n ER patients, i.e. the crazy, drunk, drugged, weird family dynamics, etc. SO that initiative is meeting some resistance......

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Specializes in ER.

TraumaNurseRN........Thanks!!!! I just did triage the other day. There was this patient who had fx'd a toe and demanded she be seen NOW. We had other patient's who where waiting to be seen from migraines, abdominal pain with n/v/d.....who in the world did this toe pain think she was? Customers are not always right.

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Our ER recently started hourly rounding in order to increase patient satisfaction. One of the main complaints patients and their families have is that "no one has been in", we all know this is usually untrue but it is their perception. It does not have to be the patient's primary nurse, it can be a paramedic or Charge nurse or another nurse, as long as someone checks on the patient and their comfort and give them some idea of a rough time frame. It is hard for us to remember that although time is flying by for us (because of the million things we need to do for the other patients) the patient and their family have nothing better to do than sit and watch the clock. It is really hard when you are on the other end of things. I think if everyone is on-board and helping it is do-able but is unrealistic for one person to do, all the time.

The other new thing is bedside reporting in the ER. I understand why the director wants to do this ( this way the patient gets introduced to the oncoming shift and gets and idea of what they are waiting for, etc) but you CAN NOT always give bedside reports n ER patients, i.e. the crazy, drunk, drugged, weird family dynamics, etc. SO that initiative is meeting some resistance......

Our patients actually have 19 inch flat panel TVs in their rooms:D....that certainly helps

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Specializes in ER, Forensics.

If people are complaining that "noone has been in" doing hourly rounds isn't going to help. Then you'll just get "they didn't come see me for a WHOLE hour after I asked for pain medicine/pee pot/hot blankie/have my foot scratched/etc."

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Specializes in ER,ICU,L+D,OR.

hourly dilaudid will help

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Specializes in Trauma, Tele, Neuro, Med-Surg.

I just moved to the ER from a tele floor, where were had hourly rounding (still stupid there). I was pleased to see we didn't do it in the ER...until a few days after I arrived and the new ER hourly rounding sheets showed up! They couldn't even figure out where to put them since there weren't any real doors in the ER, and the dumb things were designed for doors on the regular floors. The powers that be didn't like that most people signed it at the beginning of the shift, then wrote a line down through the rest of the form to the end of the shift, so they made NEW forms, which had pie charts, divided into the hours of the shift. I guess they thought we could only draw straight lines, and not circles...WRONG!

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Specializes in Emergency Nursing.
hourly dilaudid will help

Or maybe hourly ativan sprays similar to what the grocery stores use to keep produce fresh. We could just have a sprayer above each bed and every hour on the hour, it would keep our patients docile and satisfied.

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Or maybe hourly ativan sprays similar to what the grocery stores use to keep produce fresh. We could just have a sprayer above each bed and every hour on the hour, it would keep our patients docile and satisfied.

Oh quit teasing me, I have been dying to put in a request to engineering to install automatic ativan dispensers in each area, just a little spritz into the air via the ventilation system, nothing fancy......LOL, if only our wishes came true!!!!

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We were just given the "word" at our ER that this mandatory hourly rounding was a big "STATE" issue and it would now be required. Well, the only thing I can say about all that is "sure, whatever you say". I work in a small rural ER with 2 RN's staffed and if we have 2 codes, a psych and ambulance coming in hot probably airway compromise I am sorry if you have a runny nose; splinter in your finger or "god forbid" an ABSCESS, you are NOT high on the totem pole of priorities. I will be as nice as is possible in the circumstances but standing in the hallway for your prescription while we are doing chest compressions and preparing to ET someone else isn't gonna make that prescription appear faster. I think "hourly" ER rounding is way impractical especially in the above described scenario. Just my 2 cents, and I'm sure that's all its worth :p

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While I know what you are saying....poking your head in is never just poking your head in anymore. Patients sometimes have this entitlement mentality that cannot be met in the ER setting, nor should it ever be a part of the philosophy of care. Sure, nurses need to be nice and meet the needs of the patient. But unless it's an emergency...then patient's and their families need to either be educated that a warm blanket or a cup of water or pillow fluff realy isn't in the plan of the nurse coding her patient next to your family member, or the sick patient on the other side of your family member, or the push of management to discharge the other to make room for the new patient, or the admitted patient the nurse has to take up to their ICU room. 15 minutes is 15 minutes....and in those 15 minutes....sometimes the nurse is trying to empty their bladder while organizing her next plan of action, or she is giving an acute patient the proper care they need. Sure 15 minutes can seem like an hour if you are in pain, worried or afraid....but sheesh...15 minutes of pain, worry or fear is nothing in the whole scope of things. Immediate emergency care needs to go to immediate emergency care and as old ER worker....I would think you would remember how the whole process unfolds. 15 minutes is nothing....I'll say it again...15 minutes is nothing.

15 minutes is 15 minutes. You want her to comprehend your priorities and no one can say you are wrong, in view of what you describe (coding someone and other urgent matters).

But please try to comprehend that, to someone in agonizing, brutal, unremitting pain or SOB or needing to use a toilet or being in labor or any other of life's events that are accompanied by truly ferocious pain, 15 minutes can seem an unending lifetime. Have you never experienced a fracture or the like? How can you say, essentially, that 15 minutes should be able to be endured standing on one's head? I agree that pillow fluffs for reasonably comfortable, stable patients and their clan have to wait.

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Specializes in Emergency Nursing.

"But please try to comprehend that, to someone in agonizing, brutal, unremitting pain or SOB or needing to use a toilet or being in labor or any other of life's events that are accompanied by truly ferocious pain, 15 minutes can seem an unending lifetime. Have you never experienced a fracture or the like? How can you say, essentially, that 15 minutes should be able to be endured standing on one's head? I agree that pillow fluffs for reasonably comfortable, stable patients and their clan have to wait."

But that is the entire problem with the hourly rounding. When I have to poke my head in on the reasonably comfortable patient every hour, I'm leaving the patient next door standing on his head.

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