Authors

1. Tan, Mary RN, BHS Nsg, OTNC, PGDHE, DMS
2. Lang, Dora RN, PHD, BSN, Adv Dip Nsg (Oncology)

Abstract

Review question: What is the effectiveness of nurse leader rounding and follow-up, discharge phone calls on patient satisfaction with hospital?

Objective: The objective of this review is to identify the effectiveness of nurse leader rounding and post-discharge phone calls on patient satisfaction with hospital.

Background: In the United States, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) provide an online portal for healthcare consumers to provide feedback on their experience with hospital services. It is a standardized instrument designed to collect data on patients' satisfaction with hospital services. The results are published online and accessible by the public (http://www.hcahpsonline.org).1 Healthcare consumers can compare hospitals' quality of care and select hospitals that have received positive feedback. Hospitals that are unable to provide quality care to patients may suffer reduced patient load leading to reduction of hospital revenue. Therefore, patients' satisfaction with their experience in the hospital can have a direct impact on hospital revenue.2

Hospitals that experience reduced revenue may devise plans to make improvements in their services. Nurse-led initiatives such as post-discharge telephone follow-up and nurse leader rounding have been implemented to improve nursing care and patients' satisfaction with hospital services.2-4 One study has suggested that following up on a patient's condition via telephone after discharge is quick and cost-effective in addressing their physical and psychosocial concerns thus improving their quality of life.5 Nurses who have the specialized skills and knowledge, and are acquainted with patients, are in the best position to make the follow-up discharge phone call.6 Patients may be more at ease to ask for help and to clarify their concerns and problems with nurses that telephone them, which may help to alleviate their level of anxiety.6

There is a possibility that some problems may not be identified before patients are discharged and may only surface once patients are at home. Follow-up discharge calls by a ward nurse, may help patients better manage their self-care at home and reduce the likelihood of hospital re-admission and adverse events occurring at home. If patients' needs are met before the occurrence of possible adverse events, patients' satisfaction with the hospital services could be improved.

Patient's satisfaction with care is one of the indicators that can help to determine whether patients will return to seek treatment again in the same hospital. Meeting patients' needs and relieving patients' concerns are the goals of a nurse leader and can be achieved with rounding. Patients feel respected and important when a nurse leader interacts and pays attention to them. When patients' concerns and expectation of care are met, the patient's satisfaction indicator increases.7 Providing safe, quality care to patients is one of the key areas that a nurse leader has to focus on during rounding.

Rounding is a process wherein nurse leaders make regular checks on staff and patients to ensure expected outcomes are achieved. The objectives of rounding are to note patient progress outcomes and to achieve nursing goals.8 Different types of leader rounding exist and may include rounding on staff, rounding on patients, rounding on facility (environment) and rounding for outcomes.8 Since the 19th century, rounding has been part of nursing care.10 In the 1800 Crimean War, Nightingale started the rounding of wounded soldiers.10 During the rounding, besides interacting with soldiers, Nightingale would observe the nursing care provided by her nurses. She recorded her observations of the patients, staff and the environment after each rounding, and improved the hospital environment and nursing care as a result.9,10

In the new era of nursing, rounding is perceived as making an effort to make regular rounds to check and interact with patients and staff.8 Healthcare workers have to project professional behaviors when rounding.11 Nurse leaders take on the role of overseer and supervisor of the ward and are exemplary figures for staff on how to provide patients with quality care. They have the power to influence and give recognition to staff who provide patients with excellent and conscious care. Nurse leaders have to set expectations and directions for staff to achieve targeted outcomes. Identifying patient's needs upon admission guides nurses to render appropriate care to patients and prevent patient's dissatisfaction with care. The nurse leader can address patients' concerns in a timely manner. Upon seeing the presence of a nurse leader, nurses may perceive that there is a source of support should they encounter difficult situations with patients. As a nurse leader makes rounds, she may identify gaps in nursing care and work processes, and also the attitudes of her staff.4,8

Rounding for outcomes is regular practice that involves making enquiries of staff and patients to elicit information that needs to be addressed. Asking about staff's wellness and work environment, as well as available functioning equipment ensures staff of support and care. Regular interaction with staff has been found to increase work satisfaction and reduce turnover.8 Nurses who are happy at work could influence care giving and patient's satisfaction with care received. Additionally, identifying nurses who deliver excellent care to patients and giving them timely rewards in recognition may motivate them to stay on in their roles.8

The literature has clearly identified the advantages of nurse-led, post-discharge telephone follow-up and nurse rounding for both patients and nurses. However, the methodological qualities of the studies have not been examined critically. Therefore, this review intends to critically appraise the studies for synthesis on the effectiveness of post-discharge, telephone call and nurse leader rounding on patient satisfaction.