Routine ward rounds found not to be delivering quality of care to patients

Published: 08 November 2019

The widespread practice of routine ward rounds in England, known as intentional rounding, may not be the best way for nurses to deliver care to patients, a partnership study from St George’s, University of London, Kingston University and King’s College London has revealed.

The research, the first of its kind, involved experts in the Faculty of Health, Social Care and Education. It was commissioned and funded by the National Institute for Health Research to investigate the impact of intentional rounding in hospital wards on the organisation, delivery and experience of care. It found that the practice makes only a minor contribution, if any at all, to the way nurses engage with patients.

Intentional rounding is a routine of standard regular checks with individual patients at set intervals and was introduced to hospitals in England in 2013 as part of the government’s response to care failures in the NHS.

Evidence from the study suggested intentional rounding places emphasis on transactional ‘tick box’ care delivery rather than individual care. However, patients were found to value relationship-building interactions with nursing staff, which occurred when nurses delivered care activities other than intentional rounding. 

The practice was implemented following the Francis Inquiry Report into care failures in the NHS, the research reveals. It also found that intentional rounding equipped nursing staff with a safety net against allegations of poor practice because it provided evidence of care delivery.

The study has international relevance with the approach originating in the United States of America and more recently adopted in both Canada and Australia.

In England, the research found intentional rounding was widespread, with 97 per cent of NHS Acute Trusts using it in some way. Most of these adapted the practice to include additional clinical components of care.

A previous study, also led by Professor of Health Care for Older Adults at King’s College London, Ruth Harris, while in her former role at Kingston and St George’s, identified eight theoretical explanations of how intentional rounding was thought to work. But the findings of the new report discovered only two of these were supported.

In conclusion, the report recommended caution when considering adopting practices from healthcare systems in other countries to help in times of a crisis of public confidence.

Professor of Health Research in the Faculty of Health, Social Care and Education at Kingston and St George’s, Fiona Ross, who was part of the research team, said the report has highlighted the need for more individualised care in the NHS.

“Intentional rounding has its benefits, but it shouldn’t be the only game in town. Our findings show that senior managers and nurses see beyond just ticking boxes and want time to provide care for the whole patient.”

“Intentional rounding is a paper-based exercise and overlooks the patient and nurse relationship, which is central to good care. Few of the frontline and senior nursing staff we spoke to felt intentional rounding actually improved the quality of care or the frequency of their interactions with patients and their families,” she added.