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Nursing. 2015 Feb;45(2):25-30. doi: 10.1097/01.NURSE.0000459798.79840.95.

Hourly rounding and patient falls: what factors boost success?

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At Christiana Care Health System in Wilmington, Del., Jennifer Goldsack is a research associate at the Value Institute, Susan Mascioli is the director of nursing quality and safety, and Janet Cunningham is vice president of professional excellence and associate CNO. Meredith Bergey is a research associate at the Value Institute of Christiana Care Health System.



Falls are a persistent problem in all healthcare settings, with rates in acute care hospitals ranging from 1.3 to 8.9 falls per 1,000 inpatient days, about 30% resulting in serious injury.


A 30-day prospective pilot study was conducted on two units with pre- and postimplementation evaluation to determine the impact of patient-centered proactive hourly rounding on patient falls as part of a Lean Six Sigma process improvement project. Nurse leaders and a staff champion from Unit 1 were involved in the process from the start of the implementation period, while Unit 2 was introduced to the project for training shortly before the intervention began.


On Unit 1, where staff and leadership were engaged in the project from the outset, the 1-year baseline mean fall rate was 3.9 falls/1,000 patient days. The pilot period fall rate of 1.3 falls/1,000 patient days was significantly lower than the baseline fall rate (P = 0.006). On Unit 2, where there was no run-in period, the 1-year baseline mean fall rate was 2.6 falls/1,000 patient days, which fell, but not significantly, to 2.5 falls/1,000 patient days during the pilot period (P = 0.799).


Engaging an interdisciplinary team, including leadership and unit champions, to complete a Lean Six Sigma process improvement project and implement a patient-centered proactive hourly rounding program was associated with a significant reduction in the fall rate in Unit 1. Implementation of the same program in Unit 2 without engaging leadership or front-line staff in program design did not impact its fall rate.


The active involvement of leadership and front-line staff in program design and as unit champions during the project run-in period was critical to significantly reducing inpatient fall rates and call bell use in an adult medical unit.

[Indexed for MEDLINE]

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