Implementation of Hourly Rounding in the Emergency Department to Decrease Falls

Abstract

Problem: Patient falls remain an expensive medical cost in the United States (U.S). Between October 2022 to August 2023, a 271-bed community hospital reported 42 falls in their emergency department (ED). Rounding, though required by staff, is not frequently performed. Purpose: The intent of this quality initiative (QI) was to reduce patient falls in the ED by instituting and evaluating pain, potty, possession, and positioning, the 4Ps of hourly rounding. Methods: Non-human subject’s approval was received prior to implementation. This evidence-based QI initiative was implemented over 15 weeks. Data was collected using participant surveys (Pre-Readiness/Post-Implementation Surveys, and the Fall Tracer Observation Form) and chart audits (Hourly Rounding Chart Audits). Data was collected at the dichotomous and categorical levels. The initiative was composed of an interdisciplinary team of nurse administrators (nurse leaders, informatician and director of quality and patient safety). All ED nurses (n = 87), patient care technicians (PCTs, n = 36), participated in the invervention; patients over 18 years old had their charts audited. A weekly hourly rounding education session was provided to staff. Chart audits were conducted weekly to assess adherence. Strategies from the Bingham ABCDE format was used to facilitate implementation. Results: Among the starting ED staff (100%, N = 123), 67% (n = 80) completed the Pre-Readiness Survey (RN = 67, PCT = 13). Rounding occurred every 1 hour (24.6%), 2 hours (20.1%), or at various times (55.3%). The Fall Observation Form showed that staff could categorize patients as low (36.7%), medium (26.1%), or high fall risk (37.2%). The post-implementation survey was completed by 67% of staff members (RN, n = 55; PCT, n= 5), with 78.3% (n = 47) reporting a level of comfort performing hourly rounding. A total of 14 falls occurred during project implementation (a 33.3% decrease from the 42 falls). Conclusions: This initiative did not result in a decrease of falls. Though most patients in the ED were categorized as high fall risk, further guidance is needed to ensure that interventions are in place for these patients. This project has implications for practice: reduce patient falls and improve the hospitals’ financial resources. Keywords: hourly/purposeful rounding, preventing/reducing falls, emergency department/room