Appendix A Literature Table Citation Patient Group and Sample Size Design and Level of Evidence Outcome Variables Key Results DATA Validity Themes Cann & Gardner (2012) 29-bed surgical unit over a one year period: 1115 patients pre-implement, 1069 N=2,184 Pre/post test design Cohort study Level III Comfort rounds, previous care, patient safety Per 100,000 patient hours: 13.9 10.9 P=0.500 Not statistically significant Quelly score: 10 Possible bias due to self reporting, no randomization Large sample size Adequate length of time of Care” (hourly rounding) increases patient safety “Model of Care” increases patient satisfaction. Goldsack et al. (2015) Unit 1: 35 beds Unit 2: 40 beds Pre/post implementation evaluation Hourly rounding, previous care, compliance, patient falls Unit 1: P=0.006 Unit 2: P=0.799 Quelly score: 10 Short pilot period, convenience Hourly rounding is effective in falls prevention implementation:
For 30 days Cohort Level III Statistically significant for Unit 1 sampling, no randomization Staff compliance and leadership involvement is critical to implementation Hicks (2015) 14 studies reviewed addressing fall rates Systematic Review of Level II Hourly rounding, 2-hourly rounding, previous care, patient falls Fall rates decreased in 10 studies, unchanged in 3 studies, and varied in 1 study. Quelly score: 11 No randomization, varying sample sizes, varying lengths of time Hourly rounding has an effect on decreasing patient falls Kessler et al. (2012) Two critical care units and three units 6 year study Pre/post implementation surveys Cohort study Level III Hourly rounding, previous care, nurse compliance, patient safety Hourly rounding fall rate: 2.19% Previous care fall rate: 5.46% P=0.07 Not statistically significant Quelly score: 10 Length of time (6 year study), variations in staff members completing rounds, no randomization Decrease in patient falls due to hourly rounding Hourly rounding can promote patient and staff satisfaction Staff compliance and continuation is key in implementation
potential to increase patient satisfaction Hourly rounding has the potential to decrease call light usage. Saleh et al. (2011) Male stroke unit (26 beds), 104 patients over 4 period N=104 non-equivalent groups design Level III Hourly rounding, 2-hourly rounding, previous care, fall incidence Hourly rounding: 4 falls during implementation (second 4 weeks) Previous care: 25 falls prior to implementation (first 4 weeks) P<0.01 Statistically significant Quelly score: 10 Short study period, no randomization Reduction in fall incidence due to hourly rounding Hourly rounding yielded a significant reduction in call bell usage Hourly rounding reduced the occurrence of pressure ulcers Hourly rounding increased
patient satisfaction Spanaki et al. (2012) 971 consecutive patients in a 4 year study on epilepsy monitoring unit Pre/post implementation evaluation Retrospective cohort study Level III Hourly rounding, previous care, prevention agreement” Pre: 12 falls Post: 7 falls 15% reduction P=0.694 Not statistically significant Quelly tool: 11 Large sample size, adequate length of time for study, all patient data used on this specific unit, no randomization Hourly rounding decreased fall rates Hourly rounding significantly decreased the amount of missed seizures Tucker et al. (2012) Two 29-bed postoperative orthopedic units 2,295 hospitalizations during study timeframe (682 baseline period, 775 intervention period, 838 Descriptive and repeated measures design Cohort study Level III Fall rates, fall risk scores, hourly rounding fidelity, previous care Implementation vs. baseline: P=0.088 vs. baseline: P=0.375 vs. P=0.319 Not statistically significant Quelly tool: 9 Fidelity of implementation, no randomization, no control group, low baseline fall rates, large sample size Rounding reduces fall rates Proper and consistent implementation effects outcomes of rounding