Table 3

General outcomes of intentional rounding (IR)

OutcomeDescriptionExpected change in outcome
Self-report patient and staff outcomes
Patient and carer satisfaction and perceptions of care (n=24)6–8 24 25 27–29 36 40 42 46 48 49 54 64–69 71–73 Nineteen studies reported IR increased patient and/or carer satisfaction or improved their perceptions of care,6–8 24 25 27–29 36 40 42 48 49 64 65 68 69 71 73 although some had small sample sizes, low response rates, methodological concerns or did not report findings to support their claims/state whether any differences were statistically significant.28 36 65 71 Four studies reported no statistically significant differences in patient and/or carer satisfaction or perceptions of care following IR implementation,54 66 67 72 and one found mixed results.46 Majority of studies reported IR improved patient and/or carer satisfaction.
Staff satisfaction and perceptions of care (n=9)6 25 28 31 36 38 43 70 72 Four studies reported IR improved staff perceptions of care provided and/or increased job satisfaction,25 36 38 72 and two associated IR with benefits to staff turnover.36 43 Two studies associated IR with more negative staff perceptions/experiences of care.6 31 One reported a statistically significant difference between nurses’ perceived benefits of IR for patients and for themselves, identifying IR as benefiting patients but not staff.28 Some evidence of improved job satisfaction and reductions in staff turnover
Patient uncertainty/anxiety (n=1)69 One study reported that IR reduced patient uncertainty around whether a caregiver would come to their assistance for immediate needs.69 One study reporting reduction in patient uncertainty
Patient awareness of IR (n=2)35 38 There was little evidence that patients were aware of the IR process, although most felt their needs were attended to on a regular basis or that they saw their nurse ‘enough’.35 38 Limited evidence
Clinical and management outcomes
Call bell use (n=18)6 7 24–26 29 30 40 43 46 48 52 54 64–67 69 Twelve studies reported a decrease in call bell frequency following the introduction of IR,6 7 24 25 29 30 40 43 48 64 65 69 although the same concerns around anecdotal reports and a lack of findings to support these claims were noted. Three studies reported an overall increase in call bell frequency following the introduction of IR.54 66 67 Others reported mixed results, such as variations in call bell usage across different wards within the same study.26 52 Two studies concluded IR did not reduce call bell frequency,26 46 but two noted a reduction in call bell duration.6 26 Majority of studies reported call bell use decreases with IR.
Pressure ulcers (n=8)6 8 26 33 39 40 43 71 Seven studies reported a decrease in the number of hospital-acquired pressure ulcers and/or improvements in the early detection of pressure ulcers following the implementation of IR (although again some of these studies had the methodological/reporting issues previously highlighted or were based on staff reports).6 8 26 33 40 43 71 One study reported mixed results around the impact of IR on pressure ulcers.39 Majority of studies reporting decrease in number of pressure ulcers
Pain management (n=3)33 40 43 Three studies reported improvements in patients’ pain management following the implementation of IR, although two were based on staff reports only33 40 and one did not provide findings to support these claims.43 Some evidence reporting improvements in pain management
Patient falls (n=22)7 8 24–26 28 32–34 36 39 41 43 45 51 52 54 64 67 69–71 Thirteen studies reported a decrease in the number of patient falls following the implementation of IR,7 24–26 28 32–34 36 43 51 54 69 although some were based on anecdotal staff reports/perceptions only33 34 or did not report findings to support their claims/state whether any changes were statistically significant.26 28 32 36 43 Five studies reported no statistically significant change in the overall falls rate8 39 64 67 70 and one reported an increase.41 One study found initial positive gains, although falls rates returned to baseline levels in a 1-year follow-up.45 Others said decreased falls rates could be attributed to other initiatives and not necessarily IR.52 71 Majority of studies reported decrease in patient falls.
Walking distances (n=2)53 67 One study reported increased walking distances for staff as a consequence of implementing IR,53 but another found more mixed results.67 Mixed findings
Health economic outcomes
Costs (n=1)38 No clear impact of IR on hospital costs has been highlighted.38 No impact
Patient readmission rates (n=1)67 No significant differences were found in 30-day patient readmission rates between the IR intervention and control groups in one study.67 No impact
Hospital-reported patient outcomes
Leaving without being seen/against medical advice (n=1)25 IR reduced the number of patients leaving A&E without being seen by 23.4% and leaving against medical advice by 22.6% in one study.25 One study found reduction in patients leaving against medical advice.
Patient complaints (n=5)6 26 39 42 43 Three studies reported patient complaints reduced after implementing IR, although this was either based on staff report only or findings were not reported to support this claim.6 26 43 The third study acknowledged the reduction in complaints could be attributed to other ongoing initiatives and not necessarily to IR.26 Two studies either reported no change in the overall number of patient complaints associated with IR or stated that complaints were too few in number to measure a notable difference.39 42 Majority of studies reported reduction in patient complaints.