Intervention Title:
Implementing Shift-to-Shift Walking Rounds for Nurses – Edward Hospital & Health Services; Naperville, Ill.

Goal:
Decrease the amount of time nurses spend in shift-change report meetings, thereby increasing the amount of time spent with patients.

Innovation:
Staff replaced the organization's standard shift-to-shift nurse report meetings with a five-minute huddle, followed by two-person, nurse-led rounds that involve those going off shift to inform their replacements about all of the patients for whom they will provide care.

Result:
Unit nurses increased the percentage of time they spend providing direct care to patients from 38 percent, on average, to 52.7 percent.

Institution:
Edward Hospital & Health Services
801 S. Washington Street
Naperville, IL 60540
P: (630) 527-3000

From the C-Suite:
“What we didn't fully appreciate at first was the added benefit of having two sets of eyes and ears assessing a patient. By rounding together, nurses not only spend more quality time providing direct care to our patients, but they now have the opportunity to consult each other. In addition, the outgoing nurse can introduce the oncoming nurse to the patients, assuring them that they are in excellent hands. Ultimately, this collaboration results in better care for our patients.”

Trish Anen
Vice President of Operations & Chief Nursing Officer

Profile:
Edward Hospital & Health Services is a full-service, nonacademic regional health care provider in metro Chicago with 317 beds.

Clinical areas affected:

• Medical and surgical units

Staff involved:

• Medical nurses
• Surgical nurses
• Patient care technicians
• Physicians
• Surgeons
• Unit secretaries

Timeline:
Measurable increases in the amount of time nurses spend providing direct care to patients—thanks to personal digital assistants that prompt nurses to track their time/tasks—were seen within three months after the new rounding process was implemented.

Contact:
Jeri Heinzel, R.N.
Nurse Manager, Ortho/Neuro
P: (630) 527-3583
jheinzel@edward.org

Innovation implementation:
As is typical in many hospitals, Edward's two medical and two surgical units held in-person, sit-down meetings during which the charge nurse would relay information about all of the patients on the unit to nurses who were coming on shift. This process often took 30 minutes or longer.

Edward replaced these meetings with a five-minute beginning-of-shift huddle during which the charge nurse who is leaving quickly updates nurses who are beginning their shift. Each nurse then locates the unit nurse whom they are replacing and these pairs of nurses make rounds to the patients for whom they are responsible. The nurse going off shift now introduces each patient to the nurse who will be caring for them for the next eight or 12 hours; writes the new nurse's name and telephone number on a white board in the patient room; and reviews the patient's condition, vitals, etc. with the new nurse. Together, they answer any questions the patient may have. Patient care technicians (PCTs) on the unit follow the same procedure.

While the nurses and PCTs first thought this process might make patients uncomfortable, patient response has been great. Patients recognize the increased rapport among nurses on the unit, appreciate the collaborative approach to their care and acknowledge how quickly nurses are now able to respond to patient call lights when they are rounding on the unit.

Advice and lessons learned:

1. Old habits die hard. After one or two months, some nurses were reverting to their familiar habit of lingering in shift-change meetings. Implementing a cultural change that virtually abolishes longstanding protocol requires ongoing monitoring, management and positive reinforcement.
2. Talking about patients in front of them takes some getting used to. While nurses are accustomed to speaking with their patients to inform them of procedures, provide patient education, etc., they were not accustomed to relaying patient information to another nurse in the patient's presence.
3. Consider providing talking points. Many PCTs are not used to speaking in front of patients, so they found some scripting helpful at first.

Cost/benefit estimate:
Edward's four medical/surgical units continue to have a total overtime cost that is less than 3 percent of the total salary expenses for all nurses and PCTs on the units.