Effects of Nursing Rounds on Patients Fall Rates, Satisfaction, and Call Light Use in an In-patient Medical Surgical Unit

Falls among hospital patients are a persistent problem, with 2.3 to 7 falls occurring in U.S. hospitals every 1000 patient days. Approximately 30-48% percent of these falls result in injury and 5 to 10 percent of them result in serious injury. Fall related deaths occurred at a rate of 46.2 per 100,000 in 2003. Hospital falls affect both young and old patients and many of them occur when the patient is alone or involved in elimination-related activities. Falls that result in injury may lead to an extended hospitalization and increased costs . Patients who fall and sustain injury are reported to have hospital charges of more than $4,200 higher per admission than patients who do not fall. Hourly nursing rounds have been shown to decrease falls by 52% .

Hospitalized patients often require assistance with basic self-care tasks, such as using the toilet, ambulating, and eating; they ask for assistance by using the call light. Therefore, a patient's level of satisfaction with nursing care depends principally upon the patient's perception of how well the nursing staff has been able to meet his or her needs. The call light can be a lifeline for hospitalized patients, but it can also impose considerable demands on nurses' time. Several studies have documented the unfavorable effects of patients' frequent use of call lights on the effectiveness of patient-care management on inpatient units, which may already be compromised by staffing shortages.

Current data at Crouse Hospital show that the fall rate on 4S is 5.05 per 1000 patient days, demonstrating significant opportunity for improvement. Data from the 6S shows a fall rate of 5.26 per 1000 patient days. As far as patient satisfaction, the percentage of patients who gave the 4S a 9 or 10 out of a possible score of 10 for overall rating of care was 56.29%. Likewise the number of patients who would definitely recommend Crouse Hospital to others was 56.25%. Both satisfaction questions (Core IP Key Results: I would prefer to return to X without hesitation, if care is needed and I would recommend X without hesitation to others) show significant opportunities for improvement. Preliminary call light usage gathered from the Hill Rom call light system, which is currently available only on 6S, showed 6,909 individual uses of the call light within a 4-week period. One can surmise from this number that patient issues are not being addressed in a timely manner and therefore significant opportunities for improvement exist. Only aggregate data will be collected. No subjects will be identified directly or through any identifiers.

The objectives of the study are to:

1. Correlate the effects of hourly nursing rounds, if any, to patient falls and call light use.
2. Determine if there are any changes in patient satisfaction levels