Clock-Based vs. Timer-Based Rounds
Understanding Timer vs. Clock-based Rounding Options in Behavioral Health: A Deep Dive into VisibleHand’s Approach
This post will shed light on why we’ve built flexibility into our product and how it ties into traditional rounding practices.
The Origins of Q15 Checks
For those unfamiliar, Q15 checks—short for "every 15 minutes"—are a cornerstone of patient safety in behavioral health settings. The idea is simple yet critical: for patients who might pose a danger to themselves or others, staff need to lay eyes on them frequently. Historically, this has been tracked on paper, often with pre-printed sheets divided into 15-minute time slots. A staff member would initial each slot, maybe jotting down a code like “BR” for bedroom or “S” for sleeping, to confirm the check was done.
The Bucket vs. Timestamp Debate
Traditionally, Q15 checks were “bucketed” into 15-minute chunks based on the clock—think 12:00, 12:15, 12:30, and so on. Staff would glance at the wall clock, do their rounds, and sign off on the corresponding slot. But here’s the catch: if a check happened at 12:01 and the next at 12:29, both observations could technically fall within their buckets, yet 28 minutes would have passed. That’s not exactly “every 15 minutes,” is it?
In recent years, some surveyors have started asking for exact timestamps to ensure checks are truly no more than 15 minutes apart. This shift makes sense if you interpret Q15 as a strict interval, but it’s thrown a wrench into the traditional bucketed system or rounding. For example, Unity Center for Behavioral Health (circa 2018) had staff log the precise minute of each check alongside location and condition. It’s a solid concept, but it’s tougher in practice—staff might just pencil in times like 7:01, 7:16, and 7:31 to make it look compliant, even if that’s not when they actually checked.
This difference between buckets and timestamps is why we’ve designed the VisibleHand app to support both approaches, what we call clock-based rounds & timer-based rounds. Let’s break them down.
Clock-Based Rounding: Familiar and Checklist-Driven
First up is what we call “clock-based rounding" which mirrors the traditional wall-clock method. In our app, patients are assigned intervals—say Q15—and their timers reset at fixed points (like 5:00, 5:15, 5:30). When you do a check, that patient is marked as 'complete' until the next round begins. It’s like a digital checklist: finish your rounds, and you’re free to assist elsewhere until the next time slot opens.
This setup is intuitive for teams used to glancing at the clock to see when their next round should begin. It’s efficient and familiar—most of our customers still prefer it. But it doesn’t guarantee checks are no more than 15 minutes apart for each patient.
Timer-Based Rounding: Precision for Compliance
Then there’s “timer-based rounding,” an alternative approach. Here, each patient has their own countdown timer that resets to 15 minutes (or whatever interval you set for a patient) after every check. Q’s are not tied to the clock on the wall—each check is due within 15 minutes of your previous check on that specific patient.
This method ensures no more than 15 minutes elapses between checks, which is a big deal if a surveyor or state agency is looking for this strict level of compliance. The timer-based approach turns your rounds into a prioritized queue: sort your patient list by time remaining, and tackle the most urgent checks first. When a timer nears 0:00, the app flags it—color changes, vibrations, even alerts to management—so overdue rounds don’t slip through the cracks.
The trade-off? It can be a mental shift for staff accustomed to clock-based routines. Instead of “it’s 12:15, time to round,” they’re trusting the app to tell them who’s due next.
Why Offer Both?
Why does VisibleHand offer both options? Because every facility is different and states/agencies have different requirements. Some prioritize staff familiarity and efficiency with clock-based rounds. Others—like those facing stricter compliance demands—need the precision of timer-based checks. We’ve seen clients switch from clock to timer systems after quality teams flagged gaps in their processes.
Beyond the Basics: Edge Cases
We’ve also built in flexibility for less common scenarios. For example, some facilities adjust rounding schedules by time of day—Q30s during the day, Q15s at night. Our app can automatically switch patient rounding schedules to fit your needs. And for patients temporarily away (say, at court or the ER), we offer a “Q-none” status to drop them from the rounding list until they return back.
Wrapping Up
At first glance, Q15 checks seem simple, but the nuances like rounding schedules, staff habits, regulatory pressures add layers of complexity. VisibleHand’s dual rounding options let you choose what fits: clock-based that mirrors many existing workflows, or timer-based for precision. Add in our other workflow customizations, and you’ve got a tool that’s as adaptable as your team needs it to be.
Have questions about how this works in practice or want to share your own rounding quirks? Reach out—I’d love to hear from you. Thanks for reading!
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