A Patient Centered Approach to Hand-off
By the Medical Shared Governance Council with the support of Lisa Wike (author)
Ineffective communication between health care workers may lead to patient safety issues and dissatisfied customers. Hospitalized patients, along with family members, have high expectations for safe, quality health care; while at the same time being treated with dignity and respect.
Organizations place a major focus on outcome indicators, including patient satisfaction. Beginning October of 2012, Medicare will compensate hospitals for the provision of superior care; as evidenced by meeting or exceeding quality performance measures. Additionally, as a Magnet designated hospital, CVMC must outperform clinical and patient satisfaction indicators.
The medical unit struggled to sustain patient satisfaction scores above other inpatient areas within the hospital, along with nationally comparative hospitals. Together with the Practice Improvement (PI) Director for Medical- Surgical Services, the medical unit shared governance council investigated the concept of bedside nursing report. In an effort to improve and sustain patient satisfaction scores, the group developed and implemented a new process for handoff or shift report.
Handoff is a means for the ongoing nurse to gather essential information on the patient so that continuous care is maintained. Traditionally, the method for shift report occurred in a centralized location on the unit. Often this was the dayroom, where nurses gathered for a verbal face-to face report on assigned patients, along with a review of the medication record. Afterwards, nursing would conduct a brief walking round, although this practice was not consistent among the entire nursing staff. With bedside nursing report, the transition of the ongoing nurse occurs at the bedside, placing the patient in the center of the process. During this time, patients are able to ask questions and perhaps add pertinent additional information related to their treatment.
Upon literature review and appraisal, the PI Director and shared governance developed and implemented the process for nursing bedside report. Members of the council were identified as early adopters. Staff were educated through various approaches: review of journal articles, flip charts, discussions in staff meetings and by reading a storyboard located in the staff lounge. Furthermore, they were given the opportunity to place comments, questions and concerns in a comment box, which were addressed by the early adopters.
A trial of implementation was initiated in late May, 2010, followed by full implementation on August 30, 2010. During the trial period, shared governance members participated in “journaling” their experience with the new practice change. The journal pages were posted on the storyboard for staff to review. Members of the medical unit leadership monitored staff compliance of performing shift report at the bedside through direct observation during shift change.
Patient satisfaction survey results have been monitored to identify improvements. Since June 2010, the medical unit has seen an upward trend in results for “how well nurses kept you informed”. These results are displayed in the following graph.
In addition, results from Hospital Survey on Patient Safety Culture were obtained. Responses from the statement “important patient care information is often lost during shift changes” were analyzed. In December 2009, prior to the implementation of nursing bedside report, 63% of the medical unit nurses disagreed with this statement. This is compared to 86% in 2011, following the implementation of the new process for shift report. Results from 2011 further revealed that the medical unit scored higher than the overall CVMC mean and the AHRQ National Benchmark on similar bed size hospitals.
Staff reports that there are fewer distractions with the new report process. Also, there is some evidence that staff are completing shift report in less time. Positive comments have also been received from patients, for example:
“…they have true compassion for patient care and going the extra mile. They are not just here to do a job but have something outstanding that should be recognized so others can learn and practice their abilities. They spent extra time explaining my condition to the oncoming nurse which was a plus because it helped the nurse coming on duty; but it also helped me, as the patient, to really know what was going on. “
Performing handoff or shift report at the bedside is valuable. By placing patients at the center of the transfer of information, they may be more informed of their hospitalization and can become an active participant in their plan of care and perhaps make better informed decisions. All of these factors can play a vital role in the patient’s satisfaction with their hospital experience.