The Effect of Purposeful Hourly Rounding on Reducing Falls in Hospitalized Patients

Introduction

Patient falls in hospitals are a severe problem that can lead to injury, increased length of stay, mortality, and other adverse outcomes. Falls are among the most frequently reported incidents in acute care hospitals and are mainly preventable adverse events (Zhao et al., 2019). Numerous contributing risk factors for patient falls can be categorized as intrinsic (patient-related) and extrinsic (system-related). Intrinsic risk factors include advanced age, impaired mobility and gait, cognitive impairment, elimination needs, and a history of falling. Extrinsic risk factors encompass inadequate nurse staffing, insufficient supervision, improper medication use like sedatives, and environmental hazards, including slick floors and poor lighting (Spano-Szekely et al., 2019). Falls can occur at the bedside, in bathrooms, during transfers and ambulation, and in other scenarios. Any resulting injuries and prolonged hospital stays incur significant costs for healthcare facilities. Falls are a nurse-sensitive quality indicator and a priority patient safety issue.

Falls with injury are reportable events with financial implications for hospitals. The Centers for Medicare and Medicaid Services considers falls one of several “never events” that should be prevented and do not qualify for higher reimbursement if they occur. Beginning in 2008, CMS discontinued higher payment for trauma resulting from inpatient falls. Fall prevention aligns with the national patient safety goal of the Joint Commission to reduce harm from falls. Various fall prevention strategies have been studied to reduce the incidence of falls in hospitals, including purposeful hourly rounding by nurses at scheduled intervals. Such proactive, regular rounding involves assessing and addressing the needs of patients, including the “4 P’s” – pain, potty needs, positioning, and placement of items in reach. This literature review aims to evaluate the current evidence on implementing structured, purposeful hourly rounding protocols to reduce fall rates in hospital units with patients at higher risk for falls.

Methods

A systematic search was conducted using the CINAHL and PubMed databases to identify relevant studies on hourly rounding to prevent hospital falls. The following search strategy was applied: (“hourly rounding” OR “intentional rounding”) AND falls AND (hospital OR inpatient). The search was limited to peer-reviewed research studies in English published between 2017 and 2022 to focus on the most current evidence. After removing duplicates, article titles and abstracts were screened for inclusion based on the following criteria: 1) examined an hourly rounding intervention performed by nurses, 2) included fall rates as a primary outcome measure, and 3) involved hospitalized adult patients. Studies that did not meet these criteria, including editorials, qualitative studies, and studies where falls were not a measured outcome, were excluded.

The full text of the remaining articles was assessed, including five studies that met the predetermined inclusion/exclusion criteria. The designs of these studies consisted of two randomized controlled trials, one retrospective cohort study, one prospective cohort study, and one observational pre-post study. Additional relevant background literature was identified through citation searching to provide context on the significance of inpatient falls as a priority problem. However, only the five studies meeting inclusion criteria were analyzed and critically appraised to answer the review question directly on the effect of hourly rounding on falls. A PRISMA flow diagram documents the process and results of article identification, screening, assessment, and final selection.

Results

Five studies published between 2019 and 2023 were included in this integrative review. These consisted of two Level I randomized controlled trials, one Level II prospective cohort study, one Level III retrospective data analysis from multiple hospitals, and one Level III pre-post interventional study. The combined sample size of patients in these five studies was over 3,900 hospitalized adults at risk for falls. While specific rounding protocols varied, the primary intervention involved nurses conducting hourly rounds with patients at set intervals to address needs like pain and toileting that could lead to falls if not proactively managed. Outcomes measured were fall incidence rates or counts before and after the implementation of rounding, along with associated cost data in one study.

Significant findings are outlined below for each study in order of strongest to weakest evidence based on study design and quality rating. The randomized controlled trial by Baker et al. (2021) examined the effect of an intelligent sock