PRACTICE IMPROVEMENT
USING THE EVIDENCE-BASED PRACTICE
SERVICE NURSING BUNDLE TO INCREASE
PATIENT SATISFACTION
Authors: Mary Kate Dilts Skaggs, DNP, RN, NE-BC, Juli F. Daniels, PhD, CCRN, CNE,NEA-BC, LRM,
Angela J. Hodge, DNP, RN, ACNS-BC, CEN, CHEP, EMT-P, and Valerie L. DeCamp, DNP, RN, AGNP, NP-C, NE-BC,
Portsmouth, OH, and Downers Grove, IL
Earn Up to 6.5 CE Hours. See page 105.
Contribution to Emergency Nursing Practice
• This quality improvement project adds to the emergency
nursing literature by demonstrating that the evidence-
based practice (EBP) of AIDET (the acronym for the 5-step
program: acknowledge, introduce, duration, explanation,
and thank you), Hourly Rounding, and Bedside Shift Report
(BSR) can have a positive impact on patient satisfaction.
• The use of auditing tools may improve compliance of
AIDET, Hourly Rounding, and Bedside Shift Report.
• Our study found a relationship between patients'
perception of time spent in the emergency department
and quality-of-care ratings.
Abstract
Introduction: Patient satisfaction and patient experience goals are
often linked to financial consequences. Although the link does exist,
the bottom line is not only about money; it’s about providing a quality
experience for ED patients and creating an environment that engages
staff. Evidence-based practice (EBP) strategies that have positive
impact on patient perceptions of their ED care and increased
Mary Kate Dilts Skaggs, Member, Columbus Chapter of ENA, is Director of
Nursing for Emergency and Outpatient Services at Southern Ohio Medical
Center, Portsmouth, OH.
Juli F. Daniels is Professor of Nursing, Chamberlain College of Nursing,
Downers Grove, IL.
Angela J. Hodge, Member, Columbus Chapter of ENA, is Emergency Services
Clinical Coordinator at Southern Ohio Medical Center, Portsmouth, OH.
Valerie L. DeCamp, is Director Of Nursing Inpatient Services and
Accreditation, Southern Ohio Medical Center, Portsmouth, OH.
For correspondence, write: Mary Kate Dilts Skaggs, Southern Ohio Medical
Center, 1805 27th Street, Portsmouth, OH 45662; E-mail: skaggsmk@somc.org.
J Emerg Nurs 2018;44:37-45
Available online 20 November 2017.
0099-1767
Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc.
All rights reserved.
https://doi.org/10.1016/j.jen.2017.10.011
January 2018 VOLUME 44 • ISSUE 1
satisfaction ratings include AIDET, Hourly Rounding, and Bedside Shift
Report, which incorporate updates of test results and explanations of
events occurring during a patient’s visit. In addition to these outcomes,
Hourly Rounding and Bedside Shift Report have been linked to patient
safety improvements. Combining these strategies, our team created
and implemented the service nursing bundle as a quality improvement
(QI) initiative, with the goal of having a positive effect on patient
experiences in emergency departments, represented by at least a 5%
increase in overall quality-of-care ranking and ratings.
Methods: This QI project involved comparing professional research
consultant (PRC) patient- satisfaction phone survey ratings from
patients before and after ED staff members completed a 1-hour service
nursing bundle class. In addition to the patient-satisfaction ratings,
1,104 audits evaluating staff use of the service bundle implementation
were collected over an 8-week period.reading document:
Results: The random observational audits showed the adoption of
the service nursing bundle as staff compliance started at 65% in
week 1 compared with 100% by week 8. Before intervention (July
2015): 50% of patients rated their overall quality of care as excellent,
yielding a benchmark ranking of 42.5 percentile. Postservice bundle
education implementation (September 2015): 60% of patients rated
their overall quality of care as excellent, increasing our ranking to the
85.5 percentile. The postservice bundle group was 1.5 times more
likely to respond “excellent” to all 5 survey questions, which was
statistically significant (z =2.82, P = 0.004). The patients’ perceptions
of total time spent in the emergency department and ratings of
“excellent” revealed a significant statistical difference (before:
35.0%, after: 49.5%, X 2 (1) = 4.24, P b 0.05).
Discussion: With the implementation of the bundle, our
emergency department experienced an 11.8% increase in the number
of patients rating their overall quality of care as excellent. This
upsurge resulted in a 40% increase in overall quality of care,
propelling our emergency department’s ranking to the 85th percentile.
Key words: Patient satisfaction; Service protocol; Nursing
bundle; Nurse caring; Quality of care
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PRACTICE IMPROVEMENT/Skaggs et al
isits to emergency departments continue to climb
V in the United States. In 2011, 136 million people
visited emergency departments. 1 Use continues to
grow despite declining numbers of ED facilities. Rural areas
have the highest rate of ED use (448 per 1,000 population)
compared with urban and metropolitan areas (324 per
1,000 population). 2 Factors such as high acuity and
surges in patient census affect ED operations and can
have a negative impact on patient satisfaction. 3 Despite
the links between high acuity, surges, and negative
patient experience, the implementation of the Centers for
Medicare and Medicaid Services (CMS) patient satisfac-
tion survey Emergency Department Consumer Assess-
ment of Healthcare Providers and Systems (ED CAHPS)
is on the horizon. 4-6 At present, this survey remains in
development, without a final decision regarding the
timeline for national implementation and public report-
ing of these results. 5,7
With ED CAHPS looming, ED leaders are challenged
to provide timely, efficient care that meets the CMS
pay-for-performance guidelines and do so in environments
in which crowding is a regular occurrence. 6,8,9 The CMS
platform incorporates clinical criteria along with satisfaction
ratings that represent patient perceptions associated with
their ED visits. ED leaders are also responsible for engaging
staff to integrate into their clinical care delivery strategies
that enhance patients’ ED experiences. 10
FIGURE 1
The Kotter Change Model. Adapted with permission from Dr. John P. Kotter.
38 JOURNAL OF EMERGENCY NURSING
Recognizing that the ED is the front door to the
hospital and that the quest for improving patient
satisfaction begins here, our facility—Southern Ohio
Medical Center (SOMC)—has, for many years, been on a
journey to improve the ED patient experience. Part of this
journey included conducting 6 focus groups, consisting of
10 ED patients in each group. The purpose of the focus
groups was to better understand patients’ experiences
during their ED visits, wait times, and staff communication
about delays. This feedback, along with our PRC
patient-satisfaction survey results and patient complaints,
served as the catalysts leading to this QI initiative. 7 Seeking
to address these identified opportunities, 2 members of our
ED team conducted a review of the literature exploring the
EBPs that have positive impact on the patient experience.
The literature review was guided by the Beryl Institute’s
definition of the patient experience as “the sum of
interactions” among the patients, their family members,
and all members of the health care team. 11,12 Focusing on
strategies to improve interactions among staff, patients, and
family members, we searched PubMed and CINAHL
databases using the key words: emergency department,
patient satisfaction, communication, rounding, and Bedside
Shift Report (BSR) to obtain articles that focused on
improving the patient experience. 13,14 This search intro-
duced our team to the service nursing bundle elements that
included Hourly Rounding, BSR, and AIDET 14
VOLUME 44 • ISSUE 1 January 2018

(Acknowledge, Introduce, Duration, Explanation, Thank
you) interaction components associated with best prac-
tices. 15,16 Based on literature and understanding that
enhancing the patient experience is a priority, 8 our team
believed that implementing the service nursing bundle
would have a positive impact on patients’ perceptions of
care. Successful implementation of this QI initiative was
defined as adapting the service bundle so it became a
consistent part of the nursing staff’s daily activities. Monthly
PRC metrics were monitored to assess patient experience
outcomes of the service nursing bundle intervention.
Methods
SETTING
SOMC is a rural 232-bed acute care, nonprofit, teaching
hospital with a 43-bed emergency department (50,000
patient visits per year), serving 8 counties in southern Ohio
and northern Kentucky. The ED patient population ranges
in age from newborn to geriatric, and the majority of the
local community is Appalachian in culture. Because of the
Appalachian influence, the family and extended family
often accompany patients to the emergency department,
magnifying the opportunities and need for meaningful
communication.
PLANNING THE INTERVENTION
Institutional review board (IRB) approval was obtained
from both the organization and the primary author’s
educational institution. One hundred forty ED nursing staff
members were invited to participate in the QI project.
Written informed consent was obtained from the ED staff
before attending the 1-hour interactive EBP service nursing
bundle education. PRC obtained consent from patients
before completing the phone survey.
The Kotter Change Model was selected to guide
this project, as ED staff work in a constant state of
urgency (Figure 1). This model has been successful in
driving organizational change and is easily applied because it
is designed to accommodate quick change and a sense of
urgency, both of which are common states in emergency
departments. 18 This 8-step model can be organized into 3
phases. In the first phase (steps 1 to 3), the leader needs to
create the climate for change, develop a coalition of
supporters, and create the vision for the change project. In
phase 2 (steps 4 to 6), it is imperative to engage and enable
the organization to make a change. This phase includes
sharing the vision, engaging the staff, and creating quick
January 2018 VOLUME 44 • ISSUE 1
Skaggs et al/PRACTICE IMPROVEMENT
wins. In the final phase (steps 7 and 8), the team consolidates
gains to produce more wins and anchor the change.
Based on phase 1 of the Kotter model, a coalition of
staff nurses were identified by the nurse manager, assistant
nurse managers, and the director of nursing, who were
asked to be the service champions leading this
patient-experience initiative. This coalition was responsible
for weekly observational audits of staff, using the service
nursing bundle.
Phase 2, the vision for change, need for action, and the
elements of the service nursing bundle were incorporated
into a 1-hour class designed by the ED Director and
Clinical Educator. The Hourly Rounding component
focused on addressing toileting needs, positioning, pain,
and location of patients’ personal belongings. BSR elements
included outgoing staff members introducing the oncoming
nurse and inviting the patient to participate in the report.
The AIDET interaction strategies included acknowl-
edging the patient and family; staff introducing themselves
and their roles; discussing duration of the visit; explaining
the visit process; and thanking the patient. The training also
linked the service bundle elements to the goal of raising
overall quality rankings by 5% and included tactics nurses
could use to integrate these EBPs into their daily work.
Expectations that these practices would be ingrained into
the emergency department culture were discussed during
the training, and staff members were introduced to the
observational audit processes and service champion roles.
Attendees were also provided with an opportunity to
role-play using the bundle elements. All nursing staff
members were invited to attend one of the 23 classes taught
by the ED director. One hundred twenty-two staff
members attended the classes that were offered over a
week, at various times, to accommodate day, evening, and
night shifts
Reinforcement, the final phase, involved providing staff
with feedback to demonstrate the impact of the service
bundle. Weekly observation audit compliance and PRC
metrics were shared with staff during huddles and through
e-mails. Staff members were also able to observe service
bundle implementation in action, which allowed them to
see how these practices were linked to patient satisfaction.
METHOD OF EVALUATION
PRC metrics and audit tool compliance were analyzed to
explore the impact of the service nursing bundle on patient
experiences. Phone survey data from patients registered for
treatment who were discharged from the emergency
department during May to September 2015, were included
in this QI project. For patients aged 17 and younger, a
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PRACTICE IMPROVEMENT/Skaggs et al
FIGURE 2
Performance Criteria for Bedside Shift Report from Observational Staff Audits. Adapted from Studer Hardwiring Excellence.
parent completed the phone survey. Patients who died in
the emergency department, were admitted, or transferred to
another facility were excluded from the phone survey.
The pre-intervention group included 100 randomly
chosen patients who received care before implementation of
the bundle. The postintervention group contained 97
different randomly chosen patients who received care after
the bundle was implemented. The 197 subjects represent
1.3% of our ED monthly volume.
Based upon our emergency department’s monthly
volume, a priori power analysis revealed that 1,074 service
nursing bundle audits were required to assess statistical
differences. Twenty-three separate audits of each bundle
element (AIDET use, Hourly Rounding, and BSR) were
obtained on both day and night shifts over an 8-week
period. These audits were conducted on different patients
and yielded 138 audits per week (all tools used are available
from the author on request). An example of the BSR audit
tool (Figure 2) was adapted from The Studer Group. 14
DATA ANALYSIS
Descriptive statistics, logistic regression, and odds ratios
were used to analyze the impact of the service nursing
bundle implementation. 17 These analyses explored re-
sponses to 5 PRC questions representing patient percep-
tions of overall quality of care, overall quality of nursing
care, nurses’ understanding and caring, nurses’ explanation
40 JOURNAL OF EMERGENCY NURSING
®
of treatment and tests, and total time spent in the ED. A
5-point Likert scale accompanied each question: 1 = Poor, 2
= Fair, 3 = Good, 4 = Very Good, and 5 = Excellent. Using
top-box methodology, only Excellent responses were used
to compare survey rating and percentile rankings before and
after bundle implementation. 4 The PRC database includes
397 hospitals. 7
Results
One hundred twenty-two staff members (92%) completed
an anonymous online survey containing demographic
questions regarding age and years of service. Eighteen staff
members were unable to participate in the service
education. All nursing staff members were involved in the
random audits. Staff demographics revealed the age of the
majority of the participants (N = 46) ranged from 20 to
29 years and (N = 60) had 5 years or less experience as ED
RNs (Table 1).
Our patient population ranged from age 6 months to
91 years old (Table 2), with a mean age of 45.85 years
(standard deviation [SD] 22.72). Other patient demo-
graphic trends indicated that the majority of patients
participating in the PRC survey were female (N = 119).
Comparable to our facility ED patient volume arrival
trends, day shift represented 65% of our sample. During
June and July, 51% of the total surveys were collected
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 Skaggs et al/PRACTICE IMPROVEMENT

TABLE 1 TABLE 2
ED staff demographics Descriptive information of patients and their ED
Demographics Total Staff Completing visits
ED Staff Service Education Age (years) Mean: 45.85 ± 22.72
140 122 (92%) Range: 6 months–91 years
Age Total Percent Gender
20–29 46 38.66% Male 78 (39.6%)
30–39 28 23.53% Female 119 (60.4%)
40–49 20 16.81% Group
50–59 18 15.13% Pre-intervention Bundle 100 (50.8%)
60–69 7 5.88% Postintervention Bundle 97 (49.2%)
Experience Shift
0–5 years 60 50.85% Day 129 (65.5%)
6–10 years 19 16.10% Night 68 (34.5%)
11–15 years 19 16.10%
16–20 years 9 7.63% Length of Stay (hours) Mean: 2.39 ± 1.31
21–25 years 4 3.39% Range: 0.30–7.25
Greater than 25 years 7 5.93% Less than 1 hour 24 (12.2%)
1–2 hours 60 (30.5%)
2–3 hours 59 (29.9%)
3–4 hours 33 (16.8%)
Greater than 4 hours 21 (10.7%)
before bundle implementation. After bundle implementa-
tion, 49% of the total surveys were collected during August (Mean ± standard deviation).

and September.
In regard to the patient experience variables, length of
stay (LOS) was categorized into 5 numeric groups (Table 2),
ranging from less than 1-hour (N = 24) to more than 4-hour
(N = 21) visits. The majority of patients in our sample
(N = 60, 30.5%) had a LOS of 1 to 2 hours. The 2- to
3-hour range (N = 59) accounted for 29.9% of our visits, and
our mean LOS was 2.39 hours (SD 1.31).
Table 3 includes the results from 1,104 audits
conducted by 12 service champions. These audits represent
13.8% of the total ED volume during the 8-week data
collection period in 2015. The first week of auditing bundle
implementation indicated that use of these elements ranged
from 52% (BSR days) to 87% (AIDET communication
nights). As time progressed, additional audits demonstrated
that bundle element use steadily increased, with an
occasional backslide (BSR 65%). The last week of the
audit results indicated 100% use of all 3 service nursing
bundle elements across both shifts.
Service bundle impact was demonstrated by an increase
in post-bundle patients rating their overall quality of care
as excellent. The analysis involved combining and using
the average percent of excellent responses in the pre-
intervention group compared with the postintervention
group; 59.8% of the postintervention group rated their
overall quality of care as excellent compared with the 48%
of the surveyed patients in the pre-bundle implementation
group (Table 4). Although this 11.8% increase was not
statistically significant (pre = 48.0%, post = 59.8%, X 2 (1) =
2756, P = 0.097), remarkably, our PRC rankings increased
from the 36th to the 85th percentile.
Table 4 also displays the differences in the percentage of
patients who responded “Excellent” in the pre- and
postintervention groups. Analyses using the average of the
pre-June to July groups (35%) and the postintervention
August to September groups (49.5%), comparing “excellent”
ratings for the LOS variable between the pre- and postinter-
vention groups yielded statistically significant differences
(pre = 35.0%, post = 49.5%, X 2 (1) = 4.24, P b 0.05).
Although analyses comparing excellent ratings between the
pre- and postintervention groups on the other 4 questions
were nonsignificant, all percentile rankings increased after
service bundle implementation.
Thirty-six out of 97 patients (37%) responded with
excellent ratings on all 5 questions after the intervention of
the EBP service-nursing bundle. Further exploration of the
pre- and post-bundle group differences indicated that the
percentage of patients in the pre-bundle group responding

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PRACTICE IMPROVEMENT/Skaggs et al

TABLE 3
Service nursing bundle: staff audits*
Date Week Communication Rounding Bedside Audits
Shift (N =)
Report
Yes No Yes No Yes No
08/03/15 Week 1 – Days 15 (65%) 8 15 (65%) 8 12 (52%) 11
Week 1 – Nights 20 (87%) 3 18 (78%) 5 16 (70%) 7 138
08/10/15 Week 2 – Days 20 (87%) 3 22 (96%) 1 18 (78%) 5
Week 2 – Nights 21 (91%) 2 16 (70%) 7 16 (70%) 7 138
08/17/15 Week 3 – Days 21 (91%) 2 23 (100%) 0 20 (87%) 3
Week 3 – Nights 22 (96%) 1 23 (100%) 0 23 (100%) 0 138
08/24/15 Week 4 – Days 18 (78%) 5 21 (91%) 2 23 (100%) 0
Week 4 – Nights 23 (100%) 0 22 (96%) 1 15 (65%) 8 138
08/31/15 Week 5 – Days 23 (100%) 0 22 (96%) 1 21(91%) 2
Week 5 – Nights 23 (100%) 0 23 (100%) 0 19 (83%) 4 138
09/07/15 Week 6 – Days 23 (100%) 0 23 (100%) 0 23 (100%) 0
Week 6 – Nights 22 (96%) 1 20 (87%) 3 22 (96%) 1 138
09/14/15 Week 7 – Days 23 (100%) 0 23 (100%) 0 21 (91%) 2
Week 7 – Nights 23 (100%) 0 23 (100%) 0 23 (100%) 0 138
09/21/15 Week 8 – Days 23 (100%) 0 23 (100%) 0 23 (100%) 0
Week 8 – Nights 23 (100%) 0 23 (100%) 0 23 (100%) 0 138
Total number of audits completed 1104

**23 weekly audits per bundle element per shift for total of 138 audits per week.

“excellent” to all 5 survey questions: (1)overall quality of
care, (2) overall quality of nursing care, (3) nurses’
understanding and caring, (4) nurses’ explanation of
treatments and tests, (5) and total time spent in the
emergency department was calculated at 0.389. The
percentage of patients in the post-bundle intervention
group responding “excellent” to all 5 questions was 0.590.
These calculations yielded an odds ratio of 1.518, indicating
that patients in the post-bundle implementation group
were 1.5 times more likely to respond “excellent” to all
5 survey questions compared with the patients in the
pre-intervention arm (z = 2.82, P = 0.004).
The relationship between LOS and patient satisfac-
tion was analyzed using separate 2-sample unpooled
t-tests (Table 5). LOS was measured in hours for the patient
group that rated time as “poor” to “very good” compared with
the patient group that rated time as “excellent.” Examining
this relationship between LOS (total time spent) and the
survey questions: quality of care, quality of nursing care, nurses’
understanding and caring, nurses’ explanation of treatments
and tests, and the overall summary score, statistically significant
differences were noted among nurses’ explanations of treatment
and tests (t [161.97] = 2.65, P b 0.01), the total time spent
(t [190.94] = 2.21, P b 0.05), and the overall summary
score (t [144.58] = 2.63, P b 0.05). These results indicate
the shorter the LOS, the more likely the patient was to reply
“excellent.”
Discussion
Results from this QI project indicate that patients at our
facility were positively influenced by the amount of
information shared by our nursing team, time spent in
the emergency department, and perceptions of caring from
our nurses. These findings, supported by the literature,
indicate that the service nursing bundle of communication,
Hourly Rounding and BSR can have a positive impact on
various attributes associated with patient satisfaction
metrics. 13,14,19,20
Our findings indicate that use of the EBP service
nursing bundle, coupled with a robust audit process,
providing feedback to staff about audit compliance, and
ongoing patient satisfaction scores can improve patient

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 Skaggs et al/PRACTICE IMPROVEMENT

TABLE 4
Monthly percent of excellent ratings and percentile rankings for 5 key PRC survey questions
PRC Question Before Before After After Before (average) After (average) P value
June July August September Intervention Intervention
June–July August–September
Overall Quality of Care 46% (28.6) 50% (42.5) 59.6% (83.7) 60.0% (85.5) 48% (35.6) 59.8% (84.6) 0.097
Overall Quality of 58% (82.4) 50% (34.4) 66.2% (95.2) 59.6% (81.2) 54% (58.4) 62.9% (88.2) 0.206
Nursing Care
Nurses’ Explanation of 50% (60.9) 56% (81.1) 64.3% (96.4) 63.5% (96) 53% (71) 63.9% (96.2) 0.120
Test/Treatment
Nurses’ Understanding 54% (61.8) 52% (43.9) 58.1% (70.9) 61.5% (87.2) 53% (52.9) 59.8% (79.1) 0.336
and Caring
Total Time spent in 36% (38) 34% (24.7) 50.9% (92.3) 48.1% (84.7) 35% (31.4) 49.5% (88.5) b 0.05 ⁎
ED (LOS)

Source: Professional Research Consultants, Inc, 2015.

* Indicates a significant difference.

perceptions of ED quality of care. The “excellent” ratings
and subsequent increase in rankings for overall quality of
care did increase after the bundle implementation across all
5 patient experience factors measured during our QI
project. These results demonstrate the power of Hourly
Rounding, bundled with BSR, and creating an environment
in which patients are informed and updated can enhance
their experience. Furthermore, these findings support the
relationship between LOS and perception of excellent
ratings. Based upon these results, it seems worthwhile to
devote time and effort to decreasing LOS.
Ongoing staff education and hardwiring of the EBP
service bundle have been critical to our service
bundle-implementation success. Two years later, staff
members have been re-educated on the service nursing
bundle or—as we say—“Service 2.0.” We also focus on
educating new hires who did not participate in the original
training. Random audits of the EBP service nursing bundle
practices by ED staff are planned. The current overall
quality of care score for the emergency department is
54% “excellent” with a percentile ranking of 68.3 (PRC,
May 2017).
Limitations
There are several limitations to this QI project, including
the generalizability of the findings to non-rural emergency
departments outside the Midwest. Our findings may not
reflect similar outcomes at other community hospitals or
academic medical centers. Our pre- and postintervention
participants were not the same patients; therefore,
perception-change measures may have been affected by
addressing different people. The patient sample size is also a

TABLE 5
t-test for length of stay compared with survey responses
Question Responses Poor–Very Good Responses Excellent Test Statistic P Value
(Mean Time in Hours) (Mean Time in Hours)
Quality of Care 2.46 2.33 0.69 0.494
Quality of Nursing Care 2.59 2.25 1.78 0.076
Nurses’ Explanation of Treatment and Test 2.69 2.18 2.65 0.009 ⁎
Nurses’ Understanding and Caring 2.51 2.31 1.05 0.300
Total Time Spent (LOS) 2.56 2.16 2.21 0.029 ⁎
Overall Score (Summary) 2.55 2.06 2.63 0.010 ⁎
* Indicates a significant difference at the 95th confidence interval.

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PRACTICE IMPROVEMENT/Skaggs et al
limitation, as it was related to the volume allotted by our
PRC contract, which specified a certain amount for
monthly phone calls for the emergency department. The
QI project team assumed the nurses used the service nursing
bundle when unobserved. The QI project team leader was
an employee, thereby potentially influencing the staff
participation. The Hawthorne effect may have been a
factor in staff audits. The amount of time available for data
collection was limited to 4 months (June to September
2015), which may have yielded very different results from a
project during the peak flu and pneumonia season.
Discharge calls were occurring during this period but
not included in this original study because a process change
occurred during this time frame. The impact of discharge
calls on our patient satisfaction ratings is unknown. Future
studies could evaluate all 4 bundle elements (communica-
tion, rounding, BSR, and discharge phone calls) and their
impact on patient satisfaction.
Implications for Emergency Nurses
EBP communication strategies, coupled with Hourly
Rounding and BSR positively influence ED patients’
perceptions of various factors associated with the patient
experience. Based on our QI project and resulting patient
satisfaction metrics, we recognize that it is paramount to
make service expectations known to all members of the ED
staff, including new hires. However, education alone does
not make the change happen, and, for this reason, we
strongly advocate that leaders conduct observational audits
of staff to assess the frequency and quality of service bundle
practices. Nurse leaders can also use patient feedback and
satisfaction metrics to reinforce the link between service
bundle implementation and positive patient experiences.
Recognizing the power of the service bundle, this does not
negate the need for ED leaders and hospital administrators
to focus on efforts aimed at decreasing ED crowding and
LOS.
Conclusions
Bundling of EBPs is familiar to nurses and is used to
improve patient care and outcomes in a variety of health
care settings. 17 This QI project demonstrated that patient
satisfaction was correlated with communication strategies
and timely care in our emergency department. Nurses, who
traditionally spend more time with patients than other
providers, have the ability to influence the patient’s
perception of care and satisfaction. Use of the EBP service
44 JOURNAL OF EMERGENCY NURSING
nursing bundle has the potential to positively impact the
patient experience and can position your emergency
department to be ready for ED CAHPS.
Since the conclusion of this QI project, SOMC
volunteered as one of 18 client hospitals who participated
in the PRC 2017 ED CAHPS pilot study. PRC used the
“Discharged to Community” version of the CMS ED
Patient Experience of Care (EDPEC) survey currently in
development. 21 PRC selected 247 patients who were seen
in the SOMC ED during January to February 2017. PRC
was able to complete 42 phone interviews, which
corresponds to a response rate of 18%. Doctor/nurse
communication composite scores in the pilot group ranged
from 66 to 88, with SOMC scoring 77. This reaffirmed to
our team the ongoing need to use EBP service nursing
bundle strategies to improve the patient experience.
Note: AIDET®, Bedside Shift Report SM, and Hourly
Rounding® are registered trademarks of The Studer Group,
LLC. All rights reserved.
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Emergency-Department-Visits-Overview.pdf. Accessed June 2014.
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