Sit Down And Round
An Approach to Improving the Patient Experience
Susquehanna Health, Williamsport PA
At Susquehanna Health, we have tried several approaches to improving patient experience. We have
done AIDET teaching at meetings (Acknowledge, Introduce, Duration, Explanation, Thank You). We have
tried managing up our handoffs. We have tried smoothing the roughed waters created by subspecialists. We have also improved our EMR so that the HCAHPS surveys are correctly tied to the
physician discharging the patient (most of the time). Overall, we found the maneuvers that relied on
physician behavior modification were not successful, even with HCAHPS feedback and coaching.
More recently we have tried something unique, a “sit down and round” at bedside project where we sit
down at bedside and round with the nurse for the patient in the room with us. It sounds simple, and it
is, in a way. This was pioneered by a palliative care physician, our medical staff chief, who just would
not give up on the idea. Of course, the hospitalists were tagged to initiate the project, and I am glad we
did.
We started the project as a pilot in October 2013, and had 3 successful months of improved HCAHPS
scores on that floor. Consequently, we rolled it out to our entire hospital around Jan 2014. Our overall
HCAHPS scores have been rising and our part, communication with physicians, has also improved. Some
recent performance data through July 2014 is attached.
A brief description of the approach follows:
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We have a folding chair (yes, Sam’s club variety metal folding chair) in every room that is leaning
against the wall (often behind the open door). It has “doctor’s chair” across the back, to try to
encourage other family members to keep it available for our use.
When we are ready to see a patient, we have the floor clerk “vocera” (the voice pager we use)
the nurse to meet us in the room. We get our folding chair and set it up at bedside and sit down
while we are talking to the patient.
The nurse is expected to move quickly into the room so we can round together. The physician
often gets started with the patient and the nurse shows up within 30-60 seconds.
By rounding together, we demonstrate to the patient that we also are coordinating our care
plan with the nurse (a HCAHPS question). The nurse may help answer questions by getting
details off the computer when needed (e.g. Did the patient get drug X last night?) or filling the
MD in with what has occurred (e.g. Have you been out of bed today? How did that go for
you?).
When we leave, we ask: Are there any more questions that I need to answer? (HCAHPS did MD
listen?). Did I explain the medical issues in a way that you understand? (HCAHPS MD question).
Do you understand your plan of care for the day?
The process to achieve the compliance and buy in needed by our physicians was more difficult than
anticipated. Initially, the hospitalists had the interaction “role played” at a couple hospitalist meetings.
This was followed by ”executive rounds” where each hospitalist rounded on the pilot floor with the CMO
and received coaching at that level.
Every patient, every day compliance is achieved by the nurses reporting whether they rounded with the
physician at bedside, whether the physician sat down, and whether the physician seemed prepared to
answer questions. The report is an excel spread sheet by room, by attending sent to the medical
director of the hospitalist group, the administrative director of the hospitalist group, the CNO, and the
Residency Director. The reports are scanned these daily and reminders are sent to those who are not
routinely sitting down. .
Every week or two, a congratulatory email is sent to the group when every hospitalist “sat down” on the
entire floor. Our compliance is >95% at this point, and it is a rare event for a hospitalist not to sit down
and round. Amazingly, when this rolled out to the ICU, we continued to sit when our subspecialist
colleagues did not. The nurses and families noticed the difference.
The process change of sitting down has been the key to improvement. We still are monitoring this
approach. The real question is -- Will it be durable if we stop the monitoring process?
Other physician leaders are missing from the report card. In our hospital, approximately 70% of
inpatients are cared for by hospitalists and family practice residency. We currently do not have a CMO
anymore and some of the other physician feedback has been through CNO driven administrative
channels. Clearly getting buy-in across the full medical staff, surgeons, intensivists, etc. has been an ongoing challenge.