1. Running head: PATIENT SAFETY AND SATISFACTION 1
Patient Safety and Satisfaction:
Bedside Shift Report and Hourly Rounding
Marjorie Celestino
University of Central Florida
November 13, 2016

2. PATIENT SAFETY AND SATISFACTION 2
Abstract
This paper focuses on the use of bedside shift report and hourly rounding for the improvement of
patient safety and satisfaction. Topics of discussion include the definition of bedside report and
hourly rounding; how applying the two affects the care of the patients and the impact it has
overall in different studies and research.

3. PATIENT SAFETY AND SATISFACTION 3
Patient Safety and Satisfaction:
Bedside Shift Report and Hourly Rounding
As nurses, we want to keep our patients comfortable and safe in their biggest
times of need. Building the nurse-patient relationship is important and you want to make
the impression to the patient that they can trust you in order to allow you to provide the
care they seek. From the beginning to the end of shift, there are steps taken to make sure
the patients receive this care while maintaining their safety and being satisfied until
discharge. This starts with bedside shift report, which is defined as "report between the
offgoing nurse and the oncoming nurse that takes place at the bedside” (Ofori-Atta,
Bibienda, Chalupka, 2015, p. 1). From then until the end of the shift, hourly rounding
takes place. According to Ford (2010), The Studer Group developed hourly rounding
where the needs of the patients were met routinely, patient safety was ensured and
problems were addressed before they occurred.
Understanding Bedside Shift Report and Hourly Rounding
Bedside Shift Report
Reports during change of shift were not always done at bedside. It used to be held
either in a conference room or at the nurses’ station and this left patients alone for a
period of time in which “research has shown that sentinel events are more likely to
occur” (Ofori-Atta, Bibienda, Chalupka, 2015, p. 1). The Agency for Healthcare
Research and Quality (AHRQ) together with The Joint Commission have been focusing
on the patient safety and satisfaction to decrease the risks, errors and costs and increase
the quality of care and improve Hospital Consumer Assessment of Healthcare Providers
and Systems (HCAHPS) scores. Some of the critical elements, according to AHRQ, of

4. PATIENT SAFETY AND SATISFACTION 4
bedside shift report include introduction to staff and patient, conducting a focused
assessment on the patient and room, and inviting the patient to participate in their care
(Ofori-Atta, Bibienda, Chalupka, 2015).
Introduction to staff and patient
Bedside shift report allows for introducing nurse and patient. The patient has built
a relationship with the prior shift and can feel more comfortable with a new face if
introduced by someone they can trust. One of the National Patient Safety Goals of The
Joint Commission in 2009 and 2010 was to implement a standardized handoff
communication process when a change of care providers occurs. The patients who
appreciated being introduced to the oncoming nurse experienced bedside shift reports and
also reported feeling safer (Maxon, Derby, Wrobleski, Foss, 2012).
Assessing patient and environment
With report in the room, the oncoming nurse can do a quick focused assessment
of the patient’s general appearance, the room and verify medications hanging and I.V.
pump settings. The oncoming nurse can question the previous nurse if the appearance of
the patient is baseline or new. Assessing the room can help move unnecessary wires, lines
or objects out the way that may lead to patient fall or injuries. High-risk medications such
as narcotics (PCA pumps) or drips can be verified with the two-nurse check to make sure
it is the right medication and settings. These are all done in order to prevent fatal
incidents to keep the patient safe (Ofori-Atta, Bibienda, Chalupka, 2015).
Passing on accurate information
Mistakes can happen where the nurse mixes up information about patients. This
can lead to confusion and misunderstanding especially if the oncoming nurse mistakenly

5. PATIENT SAFETY AND SATISFACTION 5
asks the wrong patient a question that was meant for another. Having report at the
bedside allows the patient to “have the opportunity to clarify and correct inaccuracies”
(Maxon, Derby, Wrobleski, Foss, 2012, p. 144).
Involving patient’s in their care
Giving report in the room with the patient “encourages patients to be involved
actively in their care and allows standardized communication between nursing shifts”
(Maxon, Derby, Wrobleski, Foss, 2012, p. 140). Patients can learn their plan of care as
well as if any tests or procedures that are scheduled for the shift. Allowing the patient to
listen to report allows them to voice concerns and comfortably ask questions the previous
nurse may know the answer to. Patients have a reassurance that the oncoming staff is
receiving the correct information about them. Anxiety is lessened and patients are more
satisfied (Baker, 2010).
Hourly Rounding
“Hourly rounding is a new, proactive approach to organizing nursing care that has
garnered positive results; its focus on patient-centered care has led to notably improved
patient satisfaction scores” (Ford, 2010, p. 188).
4 P’s
During hourly rounds, the 4 P’s – pain, personal needs, positioning and placement
– which are the reasons of frequent call lights, can be addressed (Ford, 2010).
Two of the P’s – pain and position – go hand in hand. If a patient is not due for
any medication, appropriate measures such as change in position can allow for temporary
comfort until the next dose. A change in position also prevents the risk for skin
breakdown and pressure ulcers, which may result in pain (Ford, 2010).

6. PATIENT SAFETY AND SATISFACTION 6
The next “P” can be either ‘personal needs’ by Ford (2010) or ‘potty’ by Lowe
and Hodgson (2012) but both mean toileting needs of the patient. Patients that are
tethered or have drains attached have constraints to their mobility and make them a risk
for falls. Nurses are able to provide the assistance these patients need to get out of bed to
prevent trips, falls and injuries (Lowe, Hodgson, 2012).
Placement refers to the “accessibility of possessions” and that frequently used
items “must remain within easy reach of the patient” (Ford, 2010, p. 189). Placing the
needs of the patient close by prevents them from trying to reach over or getting out of
bed, which in returns stops them from having injury or fall. Having the call light in reach
allows them to call for assistance rather than doing it themselves because they were not
able to communicate with someone (Lowe, Hodgson, 2012).
Increased Improvement in Safety and Satisfaction
Methods
Hospital units using bedside report and hourly rounds have gathered data to see
whether or not there was an improvement in safety, satisfaction or both when put to use.
A colon and rectal/general surgery unit at Mayo Clinic, Rochester, MN,
conducted a study on implementing bedside shift report. It involved a total of 60 patients.
Thirty were surveyed prior to the implementation of bedside report in order to compare to
the next 30. Participants involved were over age18, without cognitive impairment and
English speaking (Maxon, Derby, Wrobleski, Foss, 2012).
An hourly rounding study took place at Baltimore Washington Medical Center
where “the study’s purpose was to determine if patient satisfaction increases
significantly” (Ford, 2010). The control was a random group of patients where hourly

7. PATIENT SAFETY AND SATISFACTION 7
rounds did not take place. Patient demographics included ages 21-90, alert, oriented and
able to communicate to staff.
Results
A positive impact from the bedside shift report resulted from the study conducted
at Mayo Clinic. Added comments by patients were placed at the end of the survey such as
encouraging continuing the practice of shift change in front of the patient. Comments like
these “reinforced the importance of bedside handoff in which patients are viewed as
partners and active participants with the health care team to enhance patient safety”
(Maxon, Derby, Wrobleski, Foss, 2012, p. 143).
The hourly rounding study had no falls “possible due to the higher frequency of
patient contact” (Ford, 2010). This goes back to the 4 P’s where the needs of the patient
are addressed which decreases the chances of patients getting out of bed. High levels of
patient satisfaction including care quality and patient safety are contributed from hourly
rounding. (Ford, 2010).
Conclusion
The use of bedside report and hourly rounding improves communication between
patient and staff. It creates an environment where patient safety and quality is
emphasized. The practice of bedside report and rounding contributes to reducing patient
harm and gives the patient a better understanding of what they can expect when it comes
to their healthcare allowing them to be content throughout their hospital stay.

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References
Baker, S. J. (2010). Bedside shift report improves patient safety and nurse accountability.
Journal of Emergency Nursing, 36(4), 355-358.
Ford, B.M. (2010). Hourly rounding: a strategy to improve patient satisfaction scores. MedSurg
Nursing, 19(3), 188.
Lowe, L., Hodgson, G. (2012). Hourly rounding in a high dependency unit. Nursing Standard,
27(8), 35-40.
Maxson, P. M., Derby, K. M., Wrobleski, D. M., Foss, D. M. (2012). Bedside nurse-to-nurse
handoff promotes patient safety. MedSurg Nursing, 21(3), 140-145.
Ofori-Atta, J., Binienda, M., Chalupka, S. (2015). Bedside shift report: implications for patient
safety and quality. Nursing, 45(8), 1-4. doi: 10.1097/01.NURSE.0000469252.96846.1a