Rounding for Quality at Toronto East General Hospital is a four-part process which focuses on providing timely, high quality care to patient populations. The aim of the model is to care for patients proactively by checking on them throughout the day according to their needs and wishes. This interaction provides an opportunity for patients to voice their concerns and involve them in addressing issues, if they so desire.
Rounding for Quality builds value for both patients and staff into the traditional hourly rounding model of care. The traditional model, whereby each hour patients are asked questions pertaining to their care (about pain, toileting, physical position, and availability of their personal affects), was perceived to be extra work on top of the staff’s core duties. This perception led to lower than desired rounding compliance and hourly rounds became a transaction done to patients rather than an interaction with patients.
Rounding for Quality elevates hourly rounding within the organization by focusing on patients’ satisfaction with rounding (measurement and reporting); redesigning rounds to engage patients in their care (patient education); and using leaders on the units to regularly gauge the quality of patients’ experience to identify opportunities for teaching, improvement, and service recovery (manager rounding on patients).
The fourth component of Rounding for Quality is electronic documentation of each round, which provides a process metric. The impact of Rounding for Quality can be seen in both process and outcome measures. Hourly rounding compliance improved from a baseline of 76% in spring 2013 to consistently over 90% in 2014-15. Inpatient satisfaction has improved 3.4% from 2014 to 2015.
The Rounding for Quality model was designed to be patient and family centred. Before developing the new model, a team of Toronto East General Hospital staff spent time observing the existing rounding processes on the units and actively sought feedback from patients and families. The hospital’s Patient Experience Panel (PEP) was also engaged on several occasions to co-develop the model. The Panel provided valuable insight about their own past experiences with rounding which helped to define the problems and understand the patient’s needs
Rounding for Quality has had two major benefits for patient care. First, the increased level of patient engagement allows for more customized and appropriate care. Patients and families benefit from the opportunity to voice their concerns and take on an active role in their care. Second, by creating a model of care that is valued by staff, Rounding for Quality improves compliance with hourly rounds and increases the likelihood that patient issues will be detected and addressed in a timely manner. Overall, consistent rounding can help to reduce pressure ulcers, prevent falls, and improve satisfaction.