Practice Improvement| Volume 45, ISSUE 2, P137-143, March 2019

Nurse-Leader Collaborative Improvement Project: Improving Patient Experience in the Emergency Department

Published:December 24, 2018DOI:



      Studies show that nurse rounding is an effective means to increase patient satisfaction and quality of care and decrease patient-safety events. There is evidence to support that daily leader rounding improves patients’ hospital experience as well. Patients' experience increased confidence in their care providers, and leaders are able to address service concerns proactively. Furthermore, recent studies have addressed patient satisfaction in the ED setting as having an impact on patients’ perceptions of the health care institution as a whole. Our objective was to demonstrate the effect of hourly nursing rounds and daily leader rounds on the ED patient experience.


      We used a pre- and postintervention evaluation of Hospital Consumer Assessment of Healthcare Providers and Services (HCAHPS) survey scores. Two groups of stakeholders developed standard work for rounding. The leader group and the bedside nursing care groups used the evidence cited in this article to create their standard processes.


      During the 2-month pilot period, patient experience scores—as measured by 5 survey questions—all improved. Results will continue to be tracked monthly and reported to all stakeholders in real time to help hardwire the process change.


      Through collaboration and a participative approach, nurses and leaders used the current evidence from scholarly nursing literature as well as Lewin’s theory of change to guide a successful approach to rounding and improving patients’ experiences when receiving emergency care.

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        • Kennedy B.
        • Craig J.B.
        • Wetsel M.
        • Reimels E.
        • Wright J.
        Three nursing interventions’ impact on HCAHPS scores.
        J Nurs Care Qual. 2013; 28: 327-334
        • Manss G.
        Implementation of daily senior leader rounds using a transformational leadership approach.
        Nurse Leader. 2017; : 65-69
        • Meade C.M.
        • Bursell A.L.
        • Ketelsen L.
        Effects of nursing rounds: on patients’ call light use, satisfaction and safety.
        Am J Nurs. 2006; 106: 58-70
        • Forde-Johnston C.
        Intentional rounding: a review of the literature.
        Nurs Stand. 2014; 28: 37-42
        • Kirk K.
        • Kane R.
        A qualitative exploration of intentional nursing round models in the emergency department setting: investigating the barriers to their use and success.
        J Clin Nurs. 2016; 25: 1262-1272
        • Olrich T.
        • Kalman M.
        • Nigolian C.
        Hourly rounding: a replication study.
        MEDSURG Nurs. 2012; 21 (36): 23-26
        • Walker K.
        • Duff J.
        • Fitzgerald K.
        “Rounding” for better patient care: an evaluation of an improvement intervention implementation.
        Int J Nurs Pract. 2015; 21: 207-213
        • Dilts Skaggs M.K.
        • Daniels J.F.
        • Hodge A.J.
        • DeCamp V.
        Using the evidence-based practice nursing bundle to increase patient satisfaction.
        J Emerg Nurs. 2018; 44: 37-45
        • Reimer N.
        • Herbenre L.
        Round and round we go: rounding strategies to impact exemplary professional practice.
        Clin J Oncol Nurs. 2014; 18: 654-660
        • Weigand L.
        Customer service: the nursing bundle.
        J Emerg Nurs. 2013; 39: 454-455
        • Brosey L.A.
        • March K.S.
        Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes.
        J Nurs Care Qual. 2014; 30: 153-159
        • Langley S.
        Effects of rounding on patient care.
        Nurs Stand. 2015; 29: 51-59
        • Carroll V.S.
        • Carrigan T.
        Implementing daily purposeful leadership rounding: a broader approach to measuring quality.
        (Accessed February 15, 2018)
        • Reid S.
        Improving patient satisfaction scores with digital leader rounding.
        Health Manag Technol. 2017; 14
        • Winter M.
        • Tjiong L.
        Does purposeful leader rounding make a difference?.
        Nurs Manag. 2015; : 26-32
        • Pattison K.H.
        • Heyman A.
        • Barlow J.
        Patient perceptions of sitting versus standing for nurse leader rounding.
        J Nurs Care Qual. 2017; 32: 1-5
        • Forsgärde E.S.
        • Attebring M.F.
        • Elmqvist C.
        Powerlessness: dissatisfied patients’ and relatives’ experience of their emergency department visit.
        Int Emerg Nurs. 2016; 25: 32-36
        • Cypress B.S.
        The emergency department: experiences of patients, families, and their nurses.
        Adv Emerg Nurs J. 2014; 36: 164-176
        • Borkowski N.
        Lewin’s change theory.
        Organizational Behavior in Health Care. 3rd ed. Jones&Bartlett Learning, Burlington, MA2016: 406-409


      Susan McFarlan is Assistant Professor, Webster University, St. Louis, MO.


      Danielle O’Brien is Team Leader, 3E, Medicine/Oncology, St. Mary’s Hospital, St. Louis, MO.


      Eryn Simmons is Heart Transplant Coordinator at Barnes Jewish Hospital, St. Louis, MO.