How Hourly C.A.R.E. Rounds Can Positively Impact Your HCAHPS Scores

Rounding is nothing new in healthcare. It’s as old as some medical facilities themselves and also was a tactic used by Florence Nightingale as she went from one soldier to the next to provide care during the Crimean War! Rounding has traditionally been seen as a way to move efficiently between patients when there was more than a 1:1 ratio of providers to patients. It ensures that providers can move from one patient to the next to keep tabs on each patient’s status.

But despite its prevalence in hospitals for many, many years, rounding is experiencing a resurgence and new-found respect, as hospitals and their nursing staff recognize the critical impact that strategic rounding can have on patient satisfaction and, ultimately, patient outcomes.

Hourly rounding, in particular, provides patients with a sense of security and confidence that somebody will be back to check on them on a regular basis. It’s a great way to manage patient expectations, stay on top of changing conditions, and intervene promptly in service recovery situations. And, interestingly enough, studies have shown that hourly rounding doesn’t take more time, it can actually save time. In 2006, a study showing just that was published in the American Journal of Nursing, and hospitals around the country have replicated these results.

But effective rounding is about more than frequency. What happens during those critical interactions between patients and staff can make a big difference. Hourly rounds are a great way to deliver great care and to show that you care. I use the acronym C.A.R.E. to help staff easily remember the four critical elements of effective rounding. Okay, I know what you’re thinking—not another acronym! But face it; we’re creatures of habit. And the busier you are, the more likely you are to overlook something. Having an acronym can help you remember the essentials, and you’ll be more likely to deliver more consistent patient experiences.

C stands for comfort: this pertains to anything having to do with the patient’s physical comfort, including pain, temperature, position, lighting, or noise.
A stands for access: access to things that are important to the patient’s wellbeing, including the call button, bed controls, bedside table, phone, or water.
R stands for restroom: does the patient need any kind of assistance?
E stands for environment: what is the environment like, and what effect is it having on the patient? This category includes room temperature, noise, light, clutter, or equipment.

I have used this acronym during my workshops and find that it really resonates with healthcare professionals. It’s a quick, simple, and relevant way to do a mental reflection of what needs to occur during a rounding visit to ensure optimal care—or C.A.R.E.!

For instance, as you walk into a room, automatically touch on these four elements. You think comfort and might say, “How are you feeling? Is there anything I could do to make you more comfortable?” and discuss pain management. This discussion provides a nice opportunity to update the patient’s whiteboard. You might even ask whether the patient has certain comfort foods and make arrangements with dietary staff to provide them.

Then, evaluate the patient’s access to important things like the call button, phone, water, food, reading materials, remote control—are these things readily and easily accessible?

A proactive approach to helping patients to the restroom can prevent falls and, at the same time, contributes to comfort.

Rounds provide an opportunity to quickly scan the environment from the patient’s perspective to consider things like cleanliness, temperature, privacy, and noise. Is the room neat and tidy? How does temperature feel?

The great thing about this approach to rounding is that anyone can C.A.R.E., whether you are a doctor, a nurse, a housekeeper, or a volunteer. The bottom line is that it is my belief everybody who steps into a patient room can C.A.R.E.

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