Vol. 00 No. 0 xxxx 2012 1 Evaluation of a Standardized Hourly Rounding Process (SHaRP) Rebecca Krepper, Beryl Vallejo, Claudia Smith, Cheryl Lindy, Cheryl Fullmer, Sharon Messimer, Yun Xing, Karen Myers Introduction “Please direct your attention to the front of the plane while we review the safety features aboard this aircraft . . . ” How many times have you boarded a plane and heard this prologue? They cover everything from how to buckle your seat belt to the items you find in the pocket of the seat in front of you. Is there really anyone out there who does not know how to buckle their seat belt? Why is that included in the mandated script? When we enter the plane we leave our ability to control our environment at the door. For some this loss of control can produce anxiety and stress. Stress and anxiety can cause you to block out those things you would normally know (i.e. buckling your seat belt). Providing structure, noting what you can and cannot do (“you are free to move about the cabin when . . . ”) and a review of safety features (life vests; exit doors) are subtle reminders that there is someone who is knowledgeable and respon- sible for your safety. Healthcare has borrowed many safety ideas from the aviation industry. Implement- ing a scripted rounding process that becomes as ingrained in the nurse/patient interaction as the airline flight attendants’ prologue is the latest of these borrowed safety ideas, and was the focus of this study. Literature Review Literature on the effectiveness of patient rounds covers three decades. The types of rounds discussed 25 years ago included such activities as rounding with the physician, dis- charge rounds, and change of shift rounds. More recently, literature has focused on im- plementation of a concept called hourly nurse rounds. Routine rounds by nursing staff have been cited as a successful strategy in improving patient outcomes, patient safety, and patient satisfaction. A review of literature that focused on sched- uled nurse rounding revealed a total of 19 published studies in the last 5 years. These studies examined the effect of rounding fre- quency, staff role of the person rounding, and the rounding intervention itself. The most fre- Abstract: Current research suggests that hourly rounds on hospi- talized patients may be associated with improvements in care de- livery and in the patients’ perception of care, as well as a reduction in patient safety events. Implementing an hourly rounding proto- col involves a major change in nursing staff workflow and a sub- stantial training and education program to ensure the success of the program. This quasi-experimental study aimed to determine if a standardized hourly rounding process (SHaRP), implemented through a formal education program, would result in improved efficiency, quality, safety, and patient satisfaction metrics when compared to a less standardized process introduced through the traditional train-the-trainer method. Data were collected over a 6-month period and results were trended for an additional 6 months later to determine if significant gains were sustained over time. Significant reductions in call light use during the study pe- riod (p = .001) and the number of steps taken by the day-shift staff (p = .02) were seen on the intervention unit. Differences in the number of patient falls, 30-day readmission rates, and patients’ perception of care were not statistically significant. Keywords acute delivery models education nursing research quently mentioned outcome was an increase in patient satisfaction scores (Bourgault et al., 2008; Culley, 2008; Halm, 2009; Meade, Bursell, & Ketelsen, 2006; Meade, Kennedy, & Kaplan, 2010; Murphy, Labonte, Klock, & Houser, 2008; Sobaski, Abraham, Fillmore, McFall, & David- hizar, 2008; Tea, Ellison, & Feghali, 2008; Woodard, 2009). However, significant statistical findings were demonstrated in only four studies (Bourgault et al., 2008; Meade et al., 2006, 2010; Tea et al., 2008). Tea and colleagues analyzed 40,000 observations at four hospitals within one healthcare system. They determined that “timely staff responsiveness” had the strongest correlation (4:1 odds ratio) to overall satisfac- tion, and designed a study to improve staff re- sponsiveness through the implementation of hourly rounding to proactively meet the needs of an orthopedic patient population. Other researchers reported no difference in patient satisfaction while using a researcher-developed instrument (Gardner, Woollett, Daly, & Richardson, 2009), although statistical analysis was not mentioned. Fall rates were measured as another out- come related to scheduled rounding. Two stud- ies reported a statistically significant decrease Journal for Healthcare Quality Vol. 00, No. 0, pp. 1–8 C  2012 National Association for Healthcare Quality Journal for Healthcare Quality Journal for Healthcare Quality Journal for Healthcare Quality Journal for Healthcare Quality