download.lww.com · Web viewAll nurses working in the stroke rehabilitation unit at MetroHealth Rehabilitation Institute of Ohio, Cleveland, Ohio (number of participants in research

Supplemental Digital Content, Table 2. Research Studies of Bedside Shift-to-Shift Handoffs, January 1, 2008 to October 31, 2014

Source Type(s) of Outcome(s) Design Study Participants Results

Athwal P, et al.J Nurs Care Qual2009;24(2):143-14717

Process and Patient Pre/post analysis of a nurse led initiative that changed the traditional group shift report in the conference room to a written/verbal combination at the patient’s bedside.

34-bed Progressive Care Unit at Sharp Grossmont Hospital in San Diego, California.There were 55 nurses, 1 educator, 15 nursing assistants, 8 monitor technicians, and 1 equipment technician (number of participants in research was not specified).

Patient falls during handoff went from 1-2 per month to one in 6 months.Time for handoff decreased from 30-60 minutes to 10-15 minutes, which resulted in an $8,000 reduction in overtime over 2 months.Call lights during shift change decreased from an average of 6 to a rarity.

Bradley S, Mott Sarah. J Clin Nurs 2014;23(13-14):1927-193618

Self-report Patient perceptions and staff perceptions of bedside handover were gathered via ethnographic interviews. Nursing staff was also surveyed about their perceptions pre/post implementation.

Acute wards within three small, rural hospitals in South Australia, Australia. The sample comprised 9 inpatients and 48 self-selected enrolled/registered nursing staff.Three inpatients from each site participated in the study. Of the staff participants, 18 participants were from site 1, 16 participants from site 2, and 14 participants from site 3.

Under the social heading, patients identified the nurse-to nurse bedside handover process as providing a bit of enjoyment and passing a few minutes of their day. Patients identified that they enjoyed meeting the nurses, getting to know the staff caring for them, and putting a name to a face. Also, patients identified that it was good to be involved in their care and know what was going on. Nurses’ perceptions changed over time to reflect that the nurses feel like their patients are more involved and less likely to be excluded from the handover process.

Cairns L, et al.J Nurs Admin2013;43(3):160-16519

Process Quality improvement study, with pre/post-implementation study.A 7-item survey was developed, pilot tested by 3 management team members and then administered via SurveyMonkey®. Two additional questions were added to the post implementation survey. Patient and nurse satisfaction, overtime, and call light activation were

The study was conducted on a 23-bed inpatient trauma unit in a large tertiary academic hospital in southwestern Pennsylvania. Twenty nine nurses completed pre-implementation surveys and 18 completed post-implementation completed surveys.

Nurses’ responses on 5 of 7-items were reported. All responses improved pre to post; statistical significance was not reported.Results on 2 Press Ganey® questions (nurses kept patient informed and patients felt included in their treatment) showed increases.Call light usage during shift change decreased by 33%.Total end-of-shift overtime minutes decreased by 913 minutes comparing 3 months before project to 3 months after. Annually, this represents a reduction of $95,680 to $143,520 in salary expense.


assessed.Carlson S.Nurs Manage2013; 44(3):52-420

Process An educational plan was developed to promote bedside reporting, which was already an institutional policy. The implementation strategy entailed a brief slide presentation and the use of a bedside report tool on each shift. Surveys were administered to the nursing staff after the implementation and the signed bedside report tools were collected after each shift.

Nurses working on a 36-bed vascular surgery/medical progressive care unit in Rochester, Minnesota.The number of pre-implementation surveys or observations was not specified. Twenty of the 65 nurses responded to the post-implementation survey. After implementation, 344 handoff tools were collected and analyzed.

Pre-implementation compliance was observed twice and showed 0% and 22% compliance. Post-implementation, the unit complied with bedside reporting 90% and 86% of the time.Of the 20 respondents, 16 (80%) stated they had used the bedside report tool and 14 (70%) stated that it helped them make bedside report a habit.The two most common reasons for not completing bedside report were that the patient was sleeping or was not in the room.

Chaboyer W, et al. J Nurs Care Qual2009;24(2):136-14221

Self-report Quality improvement project that evaluated the change to bedside handover. This was not planned as a formal study; however, a number of activities were undertaken that indirectly reflected an assessment of the improvement, namely, 6 months post-implementation written comments by staff via survey and ongoing feedback from both patients and staff.

Three units (2 medical and 1 stroke/rehabilitation) in a Queensland, Australian hospital with a total of 74 FTE nurses employed.27 nurses answered survey questions 6 months after implementation.

Nursing staff who responded to the survey agreed that the bedside handoffs had the following benefits: Support from shift coordinators and team leaders (59% agreement); improved patient safety (44% agreement); and improved patient outcomes through discharge planning (44% agreement).Patients perceived bedside handovers positively.

Chaboyer W, et al. Int J of Nurs Prac2010;16(1):27-3422

Self-report A case study was undertaken to describe the structures, processes, and perceptions of outcomes of bedside nursing handover.

Six wards in two hospitals (Research Centre for Clinical and Community Practice Innovation, Griffiths University, Gold Coast, Queensland, Australia).532 handovers observed and 34 interviews with nurses.

Staff noted an increase in continuity of care, transparency, and consistency. They also noted that bedside handover improved communication and increased accountability for accuracy. Nurses felt that they were better prepared for handover and more efficient. They also noted structural elements (staff, patients, handover sheet, and patient chart) and processes (printing handover sheet prior


to handover and asking visitors to leave, introductions and safety checks during handover, and new shift tasks initiation using handover sheet after handover).

Chapman K.Am J Nurs2009;109(11):21-2523

Process Pre-post analysis of bedside handover implementation in a single unit

One 28-bed medical-surgical telemetry unit at Wentworth-Douglas Hospital in Dover, New Hampshire, England. They used a development team of approximately 20 nurses, pharmacists, case managers, physicians, clinical coordinators, educators, and supervisors (number of participants in research was not specified).

Average time for handoff decreased from 40 minutes to 25-30 minutes.Staff also subjectively reported an increase in their ability to leave on time and their perception of continuity of care.

Dearmon V, et al.Nurs Manage2013; 21(4):668-7824

Process A mixed method evaluation and descriptive study was conducted to reflect on processes of change during TCAB implementation. Staffing data, nurse activity data,patient safety outcomes, and nurse interviews were collected from both TCAB and control units.

Two medical–surgical units were chosen: a TCAB unit and a control. The TCAB unit was a 35-bed unit specializing in the care of general surgery, trauma and orthopedic patients. The RN staff for the TCAB unit consisted of 30 full-time and part-time RNs. The control unit, a 30-bed medicalunit, provided care to stroke, oncology, human immunodeficiency.virus (HIV) and sickle cell patients. Staffing for the control unit included 25 full-time and part-time RNs.

The TCAB floor had significantly lower incidental overtime than the control during the period of intervention (during TCAB, P < .01). The overtime budget decreased an average of 56% per month (approximately $1500 per month) during implementation of TCAB. Falls with harm which decreased on the TCAB unit from an average of 1.2 per month to none per month (P < .01). There were no significant changes in patient satisfaction scores. During the TCAB experience (2008), the percentage for direct care increased significantly on the TCAB unit(mean 54.4%; P < .05) in comparison with the 2007 level, whereas on the control unit it did not change significantly (mean 47.3%; P = .30). Both units showed an increase in value-added care, with NSD between groups.

Evans D, et al.MedSurg Nurs2012;(21)5:281-29225

Self-report and Process

A pre/post evaluation of a nurse led initiative to implement a standardized report template at the bedside and bundled room assignments in a single unit.

All nurses (42 FTEs), 4 administrators, and 12 aides working on a 32-bed medical-surgical unit at the University of Michigan Hospital and Health Centers in Ann Arbor, Michigan

Average time for handoff decreased from 45 minutes pre-implementation to 29 minutes post-implementation. Nurse satisfaction with handoff increased from 37% to 78%. White board adherence increased from 25% to 98%.


Initiative was evaluated by direct observation of handoffs and a survey to nurses.

(number of participants in research was not specified).

Ford Y, et al.J Nurs Care Qual2014;29(3):371-37826

Self-report A survey was conducted and administered post-implementation of a change to bedside shift handover to patients who met inclusion criteria with their consent, which categorized items into four variables including understanding, participation, safety, and satisfaction. The survey was validated for content by multiple healthcare providers.

The study was conducted on 2 inpatient medical-surgical departments at Borgess Medical Center, a regional medical center in southwest Michigan. Both departments provide telemetry monitoring and care for patients 13 years and older. The two 46-bed departments had implemented bedside handoffs at change of shift 18 months prior to the beginning of this study. One hundred and three medical surgical adult patients completed the survey.

Participants were notably positive about the RN bedside handoff process. The more exposure patients had to the RN bedside handoff, the more positive they were about the process. Correlations between “always” encountering bedside handoff and each survey item ranged from 0.242 to 0.541 (P = .00-.02). Conversely, correlations between “rarely” experiencing bedside handoff and each survey item were generally negative, ranging from r = −0.309 to r = −0.488 (P = .00-.01). The one exception was the item that addressed whether the nurse was planning ahead to meet the patient’s needs, which was universally positive.

Freitag M, Carroll S. Q Manage Health Care2011;20(2):103–10927

Self-report and Patient

Using failure mode and effects analysis, a focus group of nurses implemented a new patient care model which included moving shift-to-shift handoff to the bedside, utilizing the EMR for handoff, and the introduction of the standardized mnemonic SBAR. Analysis was using Press Ganey® inpatient surveys and select hospital-wide nurse indicators.

The process change was piloted on a telemetry unit for 90 days, and the remaining units of the 100-bed community hospital followed over the next 9 months (number of participants in research was not specified).

Overall patient satisfaction scores on the Press Ganey® survey increased 4.4% for the pilot unit and the hospital overall after implementation. There was also an increase in 5 pre-selected Press-Ganey® items. Inpatient falls, restrained patients, and catheter associated urinary tract infections (CAUTI) decreased by 5%, 31%, and 34%, respectively, after implementation.

Friesen M, et al.J Nurs Care Qual2013;28(3):208-21628

Self-report A survey and patient interviews were used to identify opportunities for improvement with and explore patient perceptions of

The study population was derived from 8 hospital units across a multihospital system: 1 obstetric, 2 pediatric, and 5 medical units. A team of 8 nurse researchers

Overall, mean scores by patients regarding the ISHAPED process ranged from 3.6 to 4.6, with 9 of the 11 survey questions answered at 4 or above (from 1 = strongly disagree to 5 = strongly agree). The parent group also rated


the ISHAPED bedside handoff process.

surveyed and interviewed patients or parents of patients. A sub cohort of 16 patients and 6 parents from these same units were interviewed using a semi-structured interview guide.

the same 9 questions above 4.Qualitatively, 5 themes emerged: Introducing the new nurse, knowing through collaboration and communication, engaging the patient to participate and provide their perspective, educating healthcare providers, and managing privacy.

Jeffs L, et al. J Nurs Care Qual2014;29(2):149-15429

Self-report A qualitative study of bedside handover implementation where patient interviews were recorded on audiotape and transcribed for analysis. Data were analyzed using a directed content analysis approach.

This study was conducted in a 500-bed, inner-city, university-affiliated, acute-care hospital in Toronto, Ontario. Four inpatient units (nephrology, general surgery, respirology, and obstetrics and gynecology) were involved. A total of 45 interviews were conducted with patients from the following clinical cohorts: nephrology, 27% (n = 12); general surgery, 29% (n = 13); respirology, 18% (n = 8); and obstetrics and gynecology, 27% (n = 12).

Three main themes emerged: creating a personal connection, “bumping up to speed” (being informed with plan of care), and varying preferences.Patients explained that they appreciated knowing when change of shift occurred and being introduced early in the shift to the nurse who would be providing their care. Feeling comfortable to ask questions and have them answered by nurses during bedside shift handover was highly valued by patients. Most of the errors identified were related to medications or missed care. Most patients preferred to be part of the daily bedside nursing handovers; however, others did not see the need for daily bedside nursing handovers, viewing them as redundant. The later was typically reported by long-term–stay patients.

Jeffs L, et al. Nurs Leadership2013;26(3):39-5230

Self-report Registered nurses were selected by unit managers to lead the change in practice to bedside reporting and participate in meetings designed to allow collaboration and addressing of relevant issues. Trained and independent interviewers assessed qualitative outcomes using recorded and transcribed interviews.

This study was conducted in a 500-bed, inner-city, university-affiliated, acute-care hospital in Toronto, Ontario, Canada. Four inpatient units (nephrology, general surgery, respirology, and obstetrics and gynecology) were involved. Forty three interviews were conducted. Three of the units had implemented bedside handoff 6 months prior and one unit had implemented it 15 months prior.

Nurses originally thought bedside reporting would take longer and expressed issues regarding patient privacy.The nurse champions gained competencies to monitor progress and share feedback from patients and nurses and were supported by local leaders.Three qualitative themes arose: being supported to change and embrace, maintaining confidentiality and respecting patients’ preferences, and experiencing challenges with bedside reporting.


Jeffs L, et al. J Nurs Care Qual2013;28(3):226-23231

Self-report Nurses were interviewed by trained research assistants on previously conducted bedside shift report implementation. They were asked to describe the benefits and negative outcomes associated with the face-to-face interactions with nursing colleagues and patients.

This qualitative study was undertaken in an inner-city, acute care teaching hospital. A total of 43 interviews were conducted with female participants from the following 4 clinical cohorts: general surgery (n=16), nephrology (n=10), obstetrics and gynecology (n=10), and respirology (n=7).

Two key themes emerged: 1) clarifying information and intercepting errors and 2) visualizing patients and prioritizing care. The opportunity for patients to ask questions during the shift reporting process was also perceived positively by many nurses. Nurses were able to respond to errors more quickly. Being able to address errors and safety issues “in the moment” by nurses and patients during shift handover was viewed positively by study participants. Reporting at the bedside enabled nurses to do an initial quick assessment of each of their patients, which they viewed as a more accountable and accurate method of exchanging information on the patient’s status and it also allowed them to prioritize care on their shifts.

Johnson M, Cowin LS. J Nurs Manag 2013;21(1):121-12932

Self-report The study utilized a focus group methodology that provided a vehicle to interview and consequently explore clinicians’ ideas about communication in the workplace as a nursing team.

Six focus groups were conducted in medical and surgical wards at three major metropolitan hospitals in Sydney, Australia. Between four and seven nurses agreed to participate in each of the six focus groups held in medical and surgical wards (30 participants overall).

The themes that emerged were bedside handover strengths and weaknesses, good communication is about good communicators, and patient involvement in handover. Some nurses indicated that the bedside handover environment was disruptive and noisy. Most nurses believed that confidentiality issues with bedside handover were minimal and easily managed. Some nurses were active in involving the patient and found that appropriate, while others were not convinced or actively discouraged patient involvement by delivering handover at the door rather than the bedside. Using the verbal handover, written handover, and nursing notes was sometimes confusing and frustrating for nurses.Other issues identified were that the written handover sheet supports continuity of care,


problems with access to technology, and underlying models of care.

Kerr D, et al. J Nurs Care Qual2013;28(3):217-22533

Process In this single group, pre/post-implementation analysis, each ward introduced a similar style of bedside handover that involved the following steps: a brief group nursing handover of all patients for essential information; and individual one-to-one nursing handover at the patient’s bedside, using individual patient medical records. Analysis included direct observation and chart review.

The study was conducted in 3 different clinical wards (acute medical, acute surgical, and maternity) of an organization that has 3 acute care public hospital campuses, a day hospital, and 2 residential care facilities. The medical ward specialized in neurology and included 23 beds, the surgical ward specialized in general surgery and included 23 beds, and the maternity ward could accommodate 45 women.Five handovers per ward were observed.

A non-significant decrease in handover duration was observed at the 12-month post-intervention time period (33.5 minutes v. 30.6 minutes, P = .88). After implementation, the patients with allergies to medication were more likely to wear an allergy alert band (83.3% v. 95.4%); all patients were more likely to have their medication administered as prescribed (81.1% v. 97.3%); the identification labels were more likely to be attached to both sides of their medication charts after the introduction of bedside handover (78.7% v. 96.8%). Improvements were observed for documentation of the following: admission form (78.2% v. 92.3%); Braden tool on admission (73.6% v. 91.8%), 2 days after admission (70.0% v 84.8%), and 1 week after admission (51.5% v. 100%); and intravenous cannula (53.3% v. 81.2%)

Kerr D, et al. Int J Nurs Prac 2014;20(3):250-25734

Self-report Semi-structured interviews with nurses and midwives occurred 12 months after the introduction of bedside handover. Data were analyzed using thematic content analysis.

For the medical and surgical wards, 20 nurses were interviewed; and for the maternity ward, 10 midwives were interviewed. There were 30 total participants, 25 female and 5 male.

Two overall themes emerged: enhanced care and documentation and discretion to protect confidentiality and privacy.Overall, nurses and midwives believed that the standard of care and documentation had improved as a direct result of bedside handover, articulated in three subthemes: Enhanced continuity of care, improved nursing and midwifery documentation, and strengthened healthcare partnership. There were concerns about privacy and confidentiality of patient information disclosed during bedside handover, especially that of a private or sensitive nature.

Kerr D, et al. J Clin Nurs2014;23(11-

Self-report This was a qualitative descriptive study of semi-structured patient interviews

The study was conducted in a tertiary, urban, mixed adult and pediatric Emergency Department.

Two dominant themes identified: patients perceived that participating in bedside handoff enhances individual care and


12):1685-169335 focused on perceived benefits and limitations of bedside handoff. They used thematic content analysis of audio-taped interview scripts.

30 patients (18 male and 12 female) who had witnessed a nursing bedside shift-to-shift handover were studied.

participation in bedside handoff does not compromise privacy or confidentiality.Patients felt that bedside handoff gave them an opportunity to contribute information, increased their confidence in nursing, and was important. They expressed that bedside handoff should occur as privately as possible and discretion should be used for sensitive issues.

Klee K, et al. J Ped Nurs 2012;27(2):168-17336


Continuous performance improvement process over a 4-year period (2006-2009) to standardize nurse shift-to-shift handoff communication using RPIWs.

Nursing staff at Seattle Children’s Hospital in Seattle, Washington (number of participants in research was not specified).

At thirty days post implementation, 48% of staff agreed that the information received was organized and thorough, which rose to 98% at 60 days. At 60 days, the response to “were all of the components of the standardized report covered using a reliable source?” was 100%, and it stayed >80% for 90 days, 6 month, and 12 month time points.Use of a reliable source began to decrease and, in 2009, a second RPIW was conducted.In 2009, at the conclusion of a second workshop, 87% of nurses were following the standard sequence and 70% were completing handoff in 30 minutes. Five weeks later those percentages rose to 93% and 77% respectively.A 20% reduction in end of shift overtime was observed. 70% of family members reported being involved in the discussion of plan of care and 50% reported that increased involvement was valuable.

Laws D, Amato S.Rehabil Nurs2010;35(2):70-7437

Self-report A pre-implementation survey was administered, followed by an in-service lecture which was given to the nursing staff to educate them about bedside reports. A post-implementation survey was administered to nurses 4

All nurses working in the stroke rehabilitation unit at MetroHealth Rehabilitation Institute of Ohio, Cleveland, Ohio (number of participants in research was not specified).

After the 4-month implementation period the percent agreement that bedside reporting: improved safety, included patient discussion, promotes teamwork, and held staff accountable all increased. Of note, more staff also agreed that bedside reporting violates patient confidentiality after 4 months.There was NSD in the number of staff that


months after bedside reporting was initiated.

agreed with the statement that bedside report took longer.

Liu W, et al. Int J Nurs Stud2012;49(8):941-95238

Self-report The study consisted of a critical ethnographic approach to describe the social and power struggles embedded in handover practices.

All nurses and all patients capable of communicating with the staff about their medications on the selected two medical wards in a teaching hospital in Melbourne, Australia were eligible.The study consisted of 76 nurses, 27 patients, 290 hours of participant observations, 72 field interviews, 34 hours of video-recordings, and 5 reflexive-focus groups.

Handovers involving patients in the public spaces at the bedside facilitated a partnership model in medication communication. During bedside handovers, off-going nurses relied on oncoming nurses to check patients’ medication charts and medication administration rates. Bedside handovers provided an opportunity for patients to feedback effects of medication treatment. Nurses exercised discretion during bedside handovers by discussing sensitive information away from the bedside.

Lu S, et al. Int J Nurs Prac 2014;20(5):451-45939

Self-report After the implementation of bedside handoff, semi-structured, in-depth, and audio-taped patient interviews were conducted.

This study took place in three different clinical wards (acute medical, acute surgical and maternity ward) in a health organization in the state of Victoria in Australia.The study recruited a purposive sample of 30 patients who had been involved in at least 2 bedside handoffs and were admitted to one of the three wards where bedside handover had been implemented for at least 12 months. An equal number of patients (n = 10) was recruited from each of ward, leading to a total sample of 30 patients (8 males and 2 females).

Four Main themes arose: a more effective and personalizes approach; being empowered and contributing to error minimization; privacy, confidentiality, and sensitive topics; and need for training and minimizing the use of technical jargon. The majority of patients in this study expressed positive attitudes about the bedside handover approach. They felt that being included into the handover process made this practice more personal. Most patients were craving for information related to their conditions. Patients indicated that they would prefer to be informed and believed they have the right to know what is going on.The majority of patients indicated that they were comfortable with their medical condition and medication-related issues being discussed during bedside handover.Although majority of patients considered bedside handover as well conducted, a few hinted there was a room for improvement. More specifically, patients appeared to have


some concerns about whether the content discussed could be fully understood by younger nurses and patients themselves.

Maxson PM, et al. Medsurg Nurs2012;21(3):140-14440

Self-report A survey was given to staff and patients to assess satisfaction levels both pre- and post-implementation of bedside shift report.

30 patients pre-implementation and 30 post-implementation completed surveys, along with 15 staff nurses on one surgical unit.

A majority of staff were not satisfied with the current shift change report, but statistical improvement in nearly 4/5 measures (accountability, adequate communication, shift change medication reconciliation, and communication with physician) was achieved after the practice change. Ability to prioritize workload improved, but not significantly (P =.06).Patient satisfaction improved in the 5 measures (informed about plan of care, open communication between healthcare team, satisfaction with level of participation, care provider teamwork, and professional and private handoff). The only one to reach statistical significance was being informed about plan of care (P =.02)

McMurray A, et al. J Clin Nurs2010;19(17-18):2580-258941

Self-report This study analyzed change management with a goal of developing a standard operating protocol for bedside handover communication in two regional acute care hospitals. Observation and interview data were analyzed separately then combined to generate thematic analysis of factors influencing the change process in the transition to bedside handover.

Two regional acute care hospitals in Australia. Data included 532 semi-structured observations in six wards and 34 in-depth interviews conducted with a purposive sample of nursing staff.

Themes identified were: embedding the change as part of the big picture, linking the project to standardization initiatives, providing reassurance to the patient on safety and quality, smoothing out logistical difficulties, and learning to listen. Nurses appreciated the standardization of care and being part of a quality improvement initiative. The biggest barriers were variable shift patterns and resistance to change.

McMurray A, et al. Collegian2011;18(1):19-

Self-report A descriptive case study was conducted with patients who had experienced bedside

10 patients admitted (at least overnight) to one of two medical units in one Queensland, Australia

Four themes emerged from the analysis; 1) patients appreciated being acknowledged as partners in their care; 2) patients viewed


2642 handover during their hospitalization in 2009. Participants were asked about their views of bedside handover. Data were analyzed using thematic content analysis.

hospital. bedside handover as an opportunity to amend any inaccuracies in the information being communicated; 3) some preferred passive engagement rather than being fully engaged in the handover; and 4) most patients appreciated the inclusive approach of handover as nurse-patient interaction.

Nelson B, Massey R. J Nurs Adm 2010;40(4):162-843

Process Timeliness of reports was measured on the unit for a 7-day period in July 2004 pre-implementation. A computer-based change of shift template using SBAR was used at the bedside. Report durations were measured after the last test cycle in Oct. 2004 and re-measured in Jan. 2005 and December 2008.

Nurses on a 32-bed gastrointestinal surgical oncology unit consisting of two16-bed pods at The University of Texas, M. D. Anderson Cancer Center, Houston, Texas (number of participants in research was not specified.)

The average time spent in change of shift report had decreased 55% by 38 minutes after initial measurement, and the change was sustained for three years of measurement. Overtime costs also decreased by an estimated $73,726.35 per year.

Pearce IS, McCarry N. Nursing 2014;44(8):15-1744

Self-report Patient satisfaction data collected via unclear methods post implementation of a bedside handoff program ‘CHAT’: communication/clear, history, assessment/actions, and treatment plan/thank you.

Patient satisfaction scores from emergency department patients 1 month, 3 months, and 32 months later (number of participants in research was not specified.)

“Nurse’s courtesy”, “Patient given information about treatment”’ and “Nurses concern for privacy” satisfaction scores increased at all 3 measurement periods. After one month, “Nurse took time to listen”, and “Nurse’s attention to needs” patient satisfaction scores went up significantly but decreased slightly between 3 and 32 months.

Radtke K. Clin Nurse Spec 2013;27(1):19-2545

Self-report A pilot bedside shift report process using ISBAR mnemonic was developed by a practice council on a medical/surgical intermediate care unit to improve patient satisfaction scores after reviewing internal patient feedback. Monitoring of patient satisfaction scores, collected by third party

An average of 25 patients participated in pre-implementation internal surveys across the organization per quarter.Monitoring of patient satisfaction was continued for 3 months, with an average of 280 patients per quarter. Post implementation, 44 patients interviewed post-implementation, as well as 20 patients via internal survey. An

There was a rise in patient satisfaction in nursing communication from 75% to 87.6% in the 6 months analyzed, without initiation of other changes that could account for this increase. Both staff and patient interviews showed qualitative, positive feedback.


Professional Research Consultants, was continued for 3 months. Staff and patients on the unit were interviewed after the implementation.

unclear number of nurses on the unit who did not participate in the planning nor implementation were also interviewed.

Reinbeck D., Fitzsimons V. Nurs Manag 2013;44(2):16-1746

Self-report All direct care nurses went through an educational session, where handouts containing evidence-based information were given. An SBAR tool was utilized for shift change reports. HCAHPS scores were measured before and after implementation.

All direct care nurses of a 592-bed acute care community hospital, Community Medical Center, Toms River, New Jersey (number of participants in research was not specified.)

An increase in HCAHPS scores in all four communication domains became apparent soon after implementation: 8% communication with nurses; 10% nurses treating patients with respect; 7% nurses listening carefully; 11% nurses explain in a way patient understands. Authors noted an increase in staff satisfaction and that the bedside report implementation has fostered a sense of teamwork among the caregivers.

Rush SK, et al. Nurs Manag2012;43(1):40-4447

Self-report At the study site, the administrators developed a nurse manager training retreat to emphasize the role of bedside handoffs, followed by a 4-hour class. They analyzed patient satisfaction scores.

Catholic Health West is a multi-site hospital system (number of participants in research was not specified).

Noted increases in three patient satisfaction survey points: the nursing staff spent the right amount of time with me, the nursing staff helped me to understand my health condition, and the nursing staff kept me informed of my daily condition. The majority of these increases were sustained for 3 years.

Sand-Jecklin K., Sherman J.J Clin Nurs 2014;23(6):1-1048


Researchers distributed anonymous patient surveys, along with a cover letter to a convenience sample of patients who had been hospitalized for at least 48 hours and were scheduled for discharge from the medical surgical units on multiple days during the month of baseline data collection. Nurse perceptions of shift

The Patient Views on Nursing Care survey was completed by 233 patients at baseline data collection, 157 patients at three-month post-implementation, and 154 patients at 13-month post-implementation. Family members completed 70 baseline surveys, 72 three month surveys, and 53 thirteen month surveys. There was nurse representation from each of the seven targeted units, and all work

The number of patient falls during shift change for all units decreased from 20 pre-implementation to 13 at three months and 4 at 13 months. Documented medication errors decreased from 20 pre-implementation to 10 at three months.Patients perceived better nurse-to-nurse communication, more patient involvement in care, more involvement in shift report and staff making sure the patient knew who his or her nurse was. Nurses perceived increased nurse accountability, increased patient


report were collected via an online survey. Data were collected on patient falls during shift change, medication errors and nurse overtime during the same month-long period.

shifts among the survey respondents.

involvement in care and increased prevention of patient safety problems as a result of implementation of bedside nursing report.

Sand-Jecklin K, et al. J Nurs Care Qual 2013;8(2):186-19449


Pre-post survey study of nurse and patient perception. Each survey was a 17-item Likert-type survey developed by the researchers, with 1= poor care and 5 = excellent care. Both surveys above were assessed for reliability using Cronbach’s α: 0.96 patient and 0.90 nurse surveys.A 3-question nursing narrative survey completed one month after implementation.Medication errors and patient falls were captured in a patient event database.Nurse overtime was calculated from time records.

7 medical-surgical units: neurology/neurosurgery, orthopedics/plastics, trauma, medicine, surgical, medical-surgical step-down, and observation. Pre-implementation, 232 patients, 70 family members, and 148 nurses completed surveys and post-implementation, 178 patients,72 family members, and 98 nurses completed the survey.

Three patient survey items had statistically significant improvements: patient knew who his or her nurse was; patient was included in discussion; and the team communicated important information from shift to shift.Seven nurse survey items had statistically significant improvements: effective means of communication; efficient means of communication; relatively stress free; helps prevent patient care delays; completed in reasonable time; ensures accountability; and promotes patient involvement in care.Medication errors decreased 50% from 20 pre-implementation to 10 post-implementation, though this was not statistically significant.Falls per month during shift change decreased 35% from 20 pre-implementation to 13 post-implementation, though not statistically significant.There was no significant change in nurse overtime.

Spanke M, Thomas T. J Nurs Care Qual2010;25(3):261-26550

Self-report, Process, and Patient

A study was performed to examine the impact of nursing assistant walking report (included bedside report) at change of shift on patient satisfaction, patient safety, falls, and pressure ulcers. In addition, they

A 50-bed orthopedic and medical-surgical unit at Beaumont Hospital in Detroit, Michigan. 28 nurse assistants responded to the survey.

Press Ganey® survey results were used to obtain pre- and post-implementation patient satisfaction data. Patient satisfaction increased from 82.5% to 84.4%. Positive responses to “staff provide care in a safe manner” decreased from 88.3% to 86.1%. Falls measured per 1,000 patient days decreased from 5.09 to 4.36. Hospital


collected data on nursing assistants’ perceptions of their work environment. Data were collected in the first 2 quarters of 2007 (pre-implementation) and 2008 (post-implementation). Nursing assistant perception data were collected 16 months post-implementation.

acquired pressure ulcers increased from 2.90 to 4.40. Call light use decreased from 53,281 in 2007 to 49,388 in 2008, even though 8 beds were added to the unit. Call light response time decreased from 10 minutes 10 seconds to 1 minute 7 seconds. Of responding nurse assistants, 96% stated teamwork and overall care provided improved post-implementation.

Street M, et al. Int J Nurs Prac2011;17(2):133-14051

Self-report A survey was administered at change of shift on 1 day, which was followed by an audit of 10 randomly selected patients per ward per week.

Two hundred fifty nine nurses from a hospital in Victoria, Australia completed the survey pre-implementation. Post-implementation 10 randomly selected patient charts per ward per week were audited for patient involvement.

Pre-implementation, 25% of nurses agreed that they were able to check patients during handover and only 2% agreed that patients were involved in the handover process. The audit of compliance with bedside handover procedures after implementation showed an improvement in the mean audit scores from 73% in the first month to 94% after 5 months. The audit included mobility and safety check, a primary nursing survey, charts checked, patient included, equipment and supply check, use of SBAR.

Thomas L,Donohue-Porter P. J Nurs Care Qual2012;27(2):116-12452

Self-report A multi-hospital study was implemented to investigate the effects of involving patients and family in the intershift handoff process. The mnemonic I PASS the BATON was implemented to cue nurses to what information should be included in handover. Educational sessions were conducted over 2 weeks. A previously published survey of nurse satisfaction was used pre- and post-implementation, as well as

Seven hospitals in the North Shore Long Island Jewish Health System, New York, participated in the project, but all published results were taken from one of the “exemplar” hospitals. (number of participants in research was not specified).

New graduates reported feeling empowered by “I PASS the BATON” mnemonic. Nurse satisfaction as measured by 6 questions administered pre- and post-implementation improved on all questions. Patient satisfaction improved on three questions: “nurses kept you informed” (4th percentile to 67th percentile); “friendliness and courtesy of staff” (19th percentile to 92n percentile); and “likelihood to recommend” (49th percentile to 61st percentile).


patient data from the Press Ganey® inpatient survey.

Tidwell T, et al.J Neurosci Nurs2011;43(4):e1-e553


Patient/family and nurse satisfaction and nursing overtime were measured 6 months before and 6 months after the implementation of bedside reporting using an a priori survey. Overtime data was analyzed pre and post-implementation.

The sample included all nurses working on a pediatric neuroscience unit at Le Bonheur Children’s Medical Center, Memphis Tennessee and all English-speaking patients/families seen on the unit. Patient/family response rate was 35% pre-implementation and 24% post-implementation, though the exact number included was not specified. Of the nursing surveys, 23/31 pre- and 17/19 post-implementation surveys were returned.

Patients, families, and nurses reported an increase in satisfaction after the implementation of bedside reporting, with statistically significant results on 2/5 patient/family questions (how well did the nurse keep you informed and did the staff show respect for you and your child’s needs) and 7/10 nurse questions (satisfaction, relevance of information, comfort asking questions, handoff is a learning opportunity, length of time is effective, interpersonal relations between shifts, patient’s condition matches handoff report, and fosters partnership and teamwork).Overtime decreased and represented a potential cost savings of nearly $13,000 annually.

Tobiano G, et al. J Clin Nurs 2013;22(1-2):192-20054

Self-report The research approach was a case study where data from individual family members represented ‘mini-cases’ or multiple units of analysis.

The study recruited a convenience sample of 8 participants who currently had family members admitted to one rehabilitation ward in a hospital in Queensland, Australia, in2009.

Three major themes emerged: understanding the situation, interacting with nursing staff, and finding value. Bedside handover demonstrated to family members that nurses were individualizing the patient’s care and allowed family member to share information that was important to them. Family members felt informed, at ease, and included in the patients care. It was notable that families did not voice concerns regarding patient privacy at the bedside.

Wakefield BS, et al. Jt Comm J Qual Patient Saf 2012;38(6):243-25355

Self-report In an effort to improve patient satisfaction regarding nursing-specific indicators, an inpatient nursing unit decided to conduct nursing shift reports at the patient’s bedside. This transition required an extensive

A single, 20-bed inpatient nursing unit in a mid-western academic health center. Conducted structured interviews with 43 patients and used a flowchart to assess 30 oncoming and 30 off-going nurse shift reports. They also collect nurse satisfaction data.

For the first six months post bedside sift report, there were significant increases in six nurse-specific patient satisfaction scores (courtesy, promptness to patient call, attitude toward requests, attention to special needs, keep patient informed, and skill). Initially, scores increased at least 8.7 points, and percentile rankings increased from the 20th to


redesign of the current process, training of all nursing staff, and pre-post measures of success. Patients were surveyed 6 months before, as well as 6 and 23 months after implementation of bedside shift reporting. Nursing staff perceptions were surveyed 4 months and 20 months post-implementation.

the 90th percentile when compared with similar nursing units in peer institutions. Subsequent analysis showed month-to-month variation and declines. Patient/family surveys showed patients were 98% satisfied, but none of the steps of bedside handoff occurred 100% of the time. The nurse survey showed that bedside handoff improved nurse to nurse communication, improved information quality and usefulness, allowed for smoother transitions, and was positively received by patients.

Wildner J, Ferri P.J Hosp Palliat Nurs2012;14(3):216-22456


Qualitative study that also included patient/family and nurse questionnaires designed to examine perception both pre and post-implementation of bedside handover.

Hospice in Emilia-Romagna area of northern Italy where patients/family members completed 15/18 surveys, and nurses completed 17/20 pre-intervention surveys and 12/20 post-implementation surveys.

Showed increases in staff and patient satisfaction. Twenty percent of patients were only slightly disturbed, while the remainder were not disturbed at all. To staff, bedside handoff was seen as lessening the duration of handoff and number of extraneous comments. Staff felt that bedside handoff allowed them to improve the organization of the shift according to priorities; to introduce themselves to and get to know new patients and family members directly; to hear the views of the patient; and see the patient and all of his/her changes. Reasons for not completing handoff varied widely and staff also noted that it was not always possible to say everything at the bedside.

Wilson R. Emerg Nurse 2011;19(1):22-2657


Between 2005 and 2006, a new clinical handover policy was implemented and incorporated into orientation programs so all clinical staff could use the same handover procedure and documentation using P-VITAL mnemonic. A survey was implemented between January and July of

Audits of 161 nurse handovers that occurred within an Australian Emergency Department in South Western Sydney, Australia. Twenty three staff responded to staff survey.

There was a trend of reduction in clinical incidents over time. Nurse satisfaction with the new handover process was high. The number of complaints decreased during the relevant period. Audits found that practice deviated from the audit criteria on 55/161 audits.


2008. Clinical incident reports were reviewed for the 12 months before implementation and then again during the audit period.

FTE, full-time equivalent; TCAB, Transforming Care At the Bedside; RN, Registered Nurse; NSD, no significant difference; EMR, electronic medical record; SBAR, situation, background, assessment, recommendations; ISHAPED, introduce, story, history, assessment, plan, error, and dialogue; v., versus; RPIW, rapid process improvement workshop; ISBAR, introduction, situation, background, assessment, recommendations; HCAHPS, Hospital Consumer Assessment of Healthcare Provider and Systems; I PASS the BATON, introduction, patient, assessment, situation, safety concerns, background, actions, timing, ownership, next; P-VITAL, presenting information, vital signs, input and output, treatments, admission or discharge, legal documents

Documents

download.lww.com · Web viewAll nurses working in the stroke rehabilitation unit at MetroHealth Rehabilitation Institute of Ohio, Cleveland, Ohio (number of participants in research