Intentional rounding in hospital wards: What works, for whom and in what circumstances? A realist synthesis

One recommendation made by the Francis Inquiry (DH, 2013) was that, “Regular interaction and engagement between nurses and patients and those close to them should be systematised though regular ward rounds”. This... [ view full abstract ]

One recommendation made by the Francis Inquiry (DH, 2013) was that, “Regular interaction and engagement between nurses and patients and those close to them should be systematised though regular ward rounds”. This recommendation received strong support from the government and the majority of NHS trusts in the UK have now introduced ‘intentional rounding’ (IR), a structured process whereby nursing staff carry out regular checks, usually hourly, with individual patients to address their positioning, pain, personal needs and placement of items. Some published studies in the USA have found benefits of IR for patient care, including a reduction in call bell use, falls and pressure sores and increased patient satisfaction. However, there is little research to support this in the UK and what research does exist has been criticised for its design weaknesses. Funding has been awarded by the National Institute for Health Research, Health Services & Delivery Research (HS&DR - 13/07/87) for a 3-year study to generate an evidence base for IR, to provide the necessary information to successfully guide the development and implementation of IR across the UK. The study, led by researchers at King’s College London, seeks to answer the question: ‘What is it about IR in hospital wards that works, for whom and in what circumstances?

A mixed-method study design is being undertaken, drawing upon a realist evaluation approach, conducted in four phases:

Phase 1: Realist synthesis of IR.
Phase 2: National survey of all NHS acute trusts in England to explore how IR is currently being implemented and supported.
Phase 3: Case studies consisting of interviews, observations and the retrieval of routinely collected ward outcome data in six wards across three geographically spread hospitals.
Phase 4: Synthesis of data from all phases.

This presentation will focus upon the findings arising from Phase 1 of the study. As available theory on the potential of IR is limited, phase 1 involves a realist synthesis of IR, drawing upon searches of the relevant academic and unpublished grey literature as well as a stakeholder consultation event to generate hypotheses on what the mechanisms of IR may be, what particular groups may benefit most or least and what contextual factors might be important to its success or failure. The realist synthesis process is ongoing and to date, 38 papers have been identified and included in the review. Nine potential mechanisms of IR have so far been identified:

• Anticipation
• Nurse-patient relationships/communication
• Accountability
• Consistency and comprehensiveness
• Allocated time
• Visibility/presence
• Staff communication
• Patient empowerment
• Crafting

These mechanisms, along with the associated contexts and outcomes of IR will be presented and discussed. The successes of theory development in this field along with the challenges of identifying programme theories and other insights from the process will also be explored.

References

Department of Health (2013). Report of the Mid Staffordshire Foundation NHS Trust Public Inquiry, Volumes 1-3. HC-898-I-III. The Stationery Office.