Optimizing Nurses' Time: Reducing Assessment Frequency in General Care

Nurses represent a limited resource in the hospital environment. For decades, inpatient nurses have conducted head-to-toe assessments in roughly the same manner. At Mayo Clinic in Rochester, Minnesota, the practice has been twice-daily head-to-toe assessments, without reviewing the benefit of this frequency (vis-à-vis once daily) for patients, staff, and the institution.

This quality improvement (QI) project in a general care setting explored whether decreasing comprehensive physical assessments from twice daily to once daily was associated with changes in patient safety or care quality. Staff satisfaction was also assessed.

After a pilot project showed the feasibility of changing to once-daily assessments, a QI project was conducted to compare a once-daily frequency of head-to-toe assessments with a twice-daily frequency for all adult patients admitted to a general medical unit. The intervention period was between August 1 and October 31, 2023; one assessment was performed between 7 AM and 7 PM in all patients not receiving hospice care or requiring more frequent assessments because of specific disease processes. Comparison data were obtained from patients who were on the unit in the three months before the intervention, from May 1 through July 31, 2023. Outcomes were patient safety events, code blue events, and rapid response team calls; hospital length of stay; performance rates of other required assessments (as a counterbalance measure), including delirium, pressure injury, and fall risk; and compliance with the new assessment schedule.

At the conclusion of the intervention period, no significant increases in reported patient safety events, code blue events, rapid response team calls, or hospital length of stay were observed. There were no decreases in compliance with required assessments, except for pressure injury, which decreased enough during the first month of the intervention to result in a statistically significant difference between the pre- and postintervention periods; however, compliance returned to baseline by the conclusion of the project. Among nursing staff, compliance with the once-daily assessment practice was high (80%), and staff feedback was positive; 96% of respondents indicated they would like to see the practice continue.

The results of this QI project suggest that head-to-toe assessment frequency in the adult general medical patient population could be reduced to once daily without adversely affecting patient outcomes or safety. Further research is warranted to examine whether these results can be extrapolated to other units and institutions.