Transitioning Nurse Handoff to the Bedside

Abstract

The emergency department is a complex environment in which reliable communication is vital for safe patient care. Communication during nurse shift report can be risky without an effective report process in practice. Reliability improves with the use of a standardized, patient-centered nurse handoff process. Quality improvement methods were used to promote reliable information exchange during nurse shift handoff through the implementation of a standardized, patient-centric bedside report process. Forty-six hospital-based emergency nurses participated in the project. Outcomes were measured through observation of bedside report process, nurse, and patient surveys. Of 13 handoffs observed, 92% occurred at the bedside and 54% of patients actively participated in the report process. The offgoing nurses adopted most elements of the handoff process, while the oncoming nurses were less successful. Nurses believed that the new process influenced their ability to respond to patient needs and patients were more satisfied with nurses. A structured, patient-centered bedside handoff process can reduce safety risk and promote satisfaction with care through reliable information exchange. This implementation template for bedside handoff engages staff and patients while translating best practice.

Examining the meaning of the language used to communicate the nursing hand‐off

“…The analytical scores for the nursing hand‐off overall, bedside and nonbedside, were lower than the program mean score, indicating that nurses, regardless of location, were using an informal storytelling style of communication to communicate patient information. These findings are consistent with previous studies, indicating the purpose of the nursing hand‐off is to communicate patient information in a descriptive, chronological manner (Chapman et al, 2016; Galatzan et al, in press, 2019; Streeter & Harrington, 2017; White‐Trevino & Dearmon, 2018). These results are consistent with how nurses communicate patient information to physicians (Renz, 2017).…”

“…The transition of care is the transference of the authority to implement patient care interventions, patient care responsibility, and the communication of patient information from one healthcare provider to another (Abraham et al, 2018; Joint Commission, 2017b; Manias et al, 2016; Orenstein et al, 2019; O'Rourke et al, 2018). The primary purpose of communication across all healthcare professions is to exchange patient information to ensure continuity of care and patient safety (Galatzan et al, 2019; Kear, 2016; White‐Trevino & Dearmon, 2018). Transition of care has a variety of names depending on the function, region, and country.…”

Effective nurse handoffs

“…5,10 Nurses who have tried NBSR felt they were more prepared to assume the care of their patients and appreciated that they were able to carry out a safety scan during the process. 5,11,12 Successful NBSR requires a flexible standardized reporting process to tailor it to individual patients; for example, to allow for a discussion of sensitive information outside the room to prevent harm to a patient who may have a terminal diagnosis. 5 Patients also need to be informed about this new process to make sure that the handoff is effective.…”

“…This practice has been shown to decrease staff overtime, increase patient and nurse satisfaction, enable the early assessment and direct visualization of the patient during report which reduces handoff errors, enhances patient safety, and reduces adverse events 5,10. Nurses who have tried NBSR felt they were more prepared to assume the care of their patients and appreciated that they were able to carry out a safety scan during the process 5,11,12. Successful NBSR requires a flexible standardized reporting process to tailor it to individual patients; for example, to allow for a discussion of sensitive information outside the room to prevent harm to a patient who may have a terminal diagnosis 5.…”

Systematic Review of Quality Improvement Projects Related to Intershift Nursing Handover

“…patients were either satisfied or their satisfaction increased relative to baseline after participating in a QI project. 21,24,30,34,39,41 However, Ayaad et al 36 found no difference in patient satisfaction scores.…”