The Impact of Purposeful Digital Rounding on One Inpatient Rehabilitation Center

Background

Cone Health, located in Greensboro, NC, operates a 49-bed Inpatient Rehabilitation Center, designed to support patients across three programs: brain injury, stroke and general. Cone Health implemented CipherHealth’s Digital Rounding Solutions to drive performance for patient experience, better prepare patients for discharge and maintain CARF (Commission on Accreditation of Rehabilitation Facilities) accreditation.

Challenge

Prior to using CipherRounds, Cone’s nurse leaders, therapy leaders and rehab center upper management staff were rounding on patients without a coordinated approach. “There wasn’t a standardized set of questions, which was challenging as every leader had their own style,” said Becky Windsor, Quality and Accreditation Coordinator. “We could not get the feedback we needed because we were all asking for different things.”

Using only results from Press Ganey surveys, which came seldom and late, there was no method in place to clearly identify opportunities within the program that allowed them to best meet the needs of and outcomes for their patients. “There was a lot of manual data analysis in Excel,” Windsor said.

Moreover, standardized information from patients and their stakeholders is necessary to maintain CARF accreditation, which includes a commitment to continuous improvement of the programs and services delivered to patients. Cone was lacking a data-driven approach to best meet these requirements.

Goal

“CipherHealth was brought on to help with leader rounding so we could look at tactics and behaviors and make sure we were driving forward on those,” Shelly Barber, Director Patient Engagement and Insights, said. “It was designed to replace archaic paper rounding tools and poorly analyzed information.”

Additionally, in order to maintain CARF accreditation for their brain, stroke and overall rehab units, Cone needed to capture the voices of their patients in real-time as well as actionable data. This would also allow staff to identify issues and remedy them during patients’ stay, which would demonstrate that leadership cared and valued their feedback.

Lastly, to address a previous lack of coordination, the same staff member would round on patients (or their family/caregiver). Using a standardized script at least three times during their stay — within 24 hours of being admitted, midway through, and 24 hours prior to discharge — Cone could create consistent touchpoints.

Impact

The impact of CipherHealth’s Digital Rounding Solutions on Cone Health’s Inpatient Rehabilitation Center was immediate. Since going live on 6/1/2021, 330 total rounds were completed across all scripts on a total of 206 unique patients by 8 staff members (rounders):

• All 206 patients rounded on received at least 1 round during their stay (any one of the 3 scripts)
• Out of the 206 patients, 58 received 2 rounds during their stay (any one of the 3 scripts) = 28%
• Out of the 206 patients, 21 received 3 rounds during their stay (all 23 scripts at least once each) = 10%

Using CipherRounds, nursing staff are rounding on up to 65% – 73% patients weekly, a significant step towards Cone’s goals. “This is a tremendous improvement from where we were before,” Windsor said. “We feel like we are getting to our patients.”

Using three set scripts — Initial Rounding, Weekly Rounding and Discharge Rounding — nurses and therapy leaders can see in real-time how patients respond to questions throughout their stay and how their responses might change over that timeframe. “Patients look forward to that weekly interaction,” Windsor said.

Early and active conversations around discharge instructions are being had with patients and their families so that nursing staff can get out in front of any questions that might arise post-discharge. “When we do a round and there is a clinical issue or lack of understanding, we are able to intervene and get patients the right support,” Barber said.

Celebrating Staff Through Caregrams

In CipherHealth’s rounding scripts, a recognition question appears and nurses and therapy leaders are prompted to ask, “Is there anyone who you would like to thank? What exactly did they do?” Patients can identify particular staff members and an email, or “Caregram,” will be sent to them.

One patient recently said “She believed in me and my goals and helped me achieve them. Her manner and her caregiving were like nothing else that I have experienced. There are not enough words to express my thoughts about her care and her as a person.” This recognition has led to an increase in morale. “The staff is energized by it and really moved by the feedback,” Windsor said.

Conclusion

In just a few months, CipherRounds is having a positive impact. Patients and their care teams are set up for success as they engage in regular, meaningful conversations. Access to aggregated, actionable data from each patient interaction has created more opportunities for timely intervention and improvements.