Hourly rounds: what does the evidence indicate?

Hourly rounds—intentionally checking on patients at regular intervals—continues to be debated in nursing circles. Often, registered nurses make rounds on even hours and support staff make rounds on odd hours from 6 AM to 10 PM (and every 2 hours from 10 PM to 6 AM). While making rounds, staff engage patients by checking on the “4 P’s”: pain, positioning, potty (elimination), and proximity of personal items. Patients are told that staff will check on them frequently, so hourly rounds help manage patients’ expectations. Patients become less anxious about getting their needs met as they learn to trust the process of hourly rounds. Attending to patients’ comfort, safety, and environmental needs may also prevent adverse events like falls, pressure ulcers, or unrelieved pain; and contribute to patients’ satisfaction with nursing care. Proponents also attest that hourly rounds organize work flow, offering efficiencies by giving nurses time back as they proactively (rather than reactively) anticipate and attend to patients’ needs. In this review I discuss available evidence about the effects of hourly rounds on clinical outcomes in inpatient settings.