Realist synthesis of intentional rounding in hospital wards: exploring the evidence of what works, for whom, in what circumstances and why

Sarah Sims, Mary Leamy, Nigel Davies, Katy Schnitzler, Ros Levenson, Felicity Mayer, Robert Grant, Sally Brearley, Stephen Gourlay, Fiona Ross, Ruth Harris

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)
322 Downloads (Pure)


Background Intentional rounding (IR) is a structured
process whereby nurses conduct one to two hourly checks
with every patient using a standardised protocol.
Objective A realist synthesis of the evidence on IR was
undertaken to develop IR programme theories of what
works, for whom, in what circumstances and why.
Methods A three-stage literature search and a stakeholder
consultation event was completed. A variety of sources
were searched, including AMED, CINAHL, MEDLINE,
PsycINFO, HMIC, Google and Google Scholar, for published
and unpublished literature. In line with realist synthesis
methodology, each study’s ‘fitness for purpose’ was
assessed by considering its relevance and rigour.
Results A total of 44 papers met the inclusion criteria. To
make the programme theories underpinning IR explicit, we
identified eight a priori propositions: (1) when implemented
in a comprehensive and consistent way, IR improves
healthcare quality and satisfaction, and reduces potential
harms; (2) embedding IR into daily routine practice gives
nurses ‘allocated time to care’; (3) documenting IR checks
increases accountability and raises fundamental standards
of care; (4) when workload and staffing levels permit, more
frequent nurse–patient contact improves relationships and
increases awareness of patient comfort and safety needs;
(5) increasing time when nurses are in the direct vicinity
of patients promotes vigilance, provides reassurance and
reduces potential harms; (6) more frequent nurse–patient
contact enables nurses to anticipate patient needs and
take pre-emptive action; (7) IR documentation facilitates
teamwork and communication; and (8) IR empowers
patients to ask for what they need to maintain their
comfort and well-being. Given the limited evidence base,
further research is needed to test and further refine these
Conclusions Despite widespread use of IR, this
paper highlights the paradox that there is ambiguity
surrounding its purpose and limited evidence of how it
works in practice.
Original languageEnglish
Number of pages165
JournalBMJ Quality and Safety
Early online date14 Mar 2018
Publication statusE-pub ahead of print - 14 Mar 2018


  • Intentional Rounding
  • realist synthesis


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