Bedside Shift Report: A Patient-Centered Approach to Improving Satisfaction Scores

Background: In 2001 the Institute of Medicine report, Crossing the Quality Chasm, included patient centeredness as one of its six overarching aims for improving the health care system.  Patient centered care can be defined as, “improving health care through the eyes of the patient”, often measured by patient experience surveys such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).  Improving the patient experience involves changing the current culture of the way nurses practice and communicate with each other and with their patients.  One way to improve these communications is to commit to bedside shift report.  Historically nursing shift to shift reports have occurred at a central nursing station on a patient care unit. Patient history, plan of care and information vital to the care of the patient are exchanged during this time. This traditional practice of one way communication from the off-going provider to the oncoming nurse can be lengthy, incomplete and fraught with interruptions. This hand off occurs with no patient involvement which can lead to errors, confusion about treatments, diagnosis and medications.  Moving report to the bedside improves transparency between the healthcare team and the patient. The patients are able to hear exactly what their plan of care entails and are free to add any pertinent information.  Achieving this level of communication does not come without establishing trust between the nursing staff and the patients.  Nurses must demonstrate empathy, respect and compassion in order to establish this type of relationship.

Objective: To measure the effects of implementing a standardized bedside shift report on patient experience.

Methods:  Beginning September 2011, all unit nurses attended an educational session to learn about bedside shift report. Each member received a handout containing evidence based information about bedside shift reporting.  A standardized tool based on the Situation, Background, Assessment, and Recommendation (SBAR) communication structure was developed to encompass all items expected to be reviewed at change of shift.  The proper way to conduct a bedside handoff with this new tool was reviewed with all staff. Questions and concerns were addresses prior to implementing the new reporting system. Over the last two weeks of November 2011, the Director of Patient Care shadowed staff to observe reporting process, identify any areas for improvement and support staff through the change. Weekly meeting were held to discuss issues and concerns relating to patient confidentiality, physician buy-in, and focusing the handoff around the patient. Bedside shift report became a mandatory requirement on December 1, 2011.

Results:

Median Domain Score	Before	After	Sustained Results 2013
	Jun-Nov 2011	Dec-Jun 2012		2014
Communication with Nurses	74	80	80	77
Nurses treat with courtesy/respect	83	91	88	84
Nurses listen carefully	66.5	71	75	72
Nurses explain in a way you understand	64	71	75	75

Immediate and dramatic results were seen related to HCAHPS nursing communication scores in all four domains. The greatest improvement was seen in the nurses explain things in a way you understand which improved from 64 to 71 or 11%.  One important indicator of the effectiveness of bedside reporting is the nurses treat with courtesy and respect scores which increased 10% from 83 to 91.  These indicators validate that nursing staff is building relationships with patients and effectively engaging patients in their care.  Some barriers were encountered during the implementation of bedside report specifically relating to patient confidentiality and physician buy-in.  Staff had concerns about sharing clinical information at the patients’ bedside and violating HIPAA.  Further education was provided to staff members on what pertinent information to share and how the sharing of information is considered incidental disclosure under the HIPAA law. One physician wanted to “opt out” of bedside shift report for their patients.  The Director of Patient Care provided further education to the physician on bedside shift report and the positive impact it would have on safety and communication, afterwards they were agreeable to the process change.

Conclusion:   The implementation of bedside shift report has significantly improved the patient experience on the unit.  Patients and their families have reported feeling more involved in their plan of care and have felt they received more information on their condition.  Staff satisfaction and perceptions of hand-off communication has also improved with the standardization of the hand-off tool.  Concise information on the patients’ condition is reported to assist the oncoming nurse appropriately plan the patients care for their shift.  Sustaining bedside report will remain the focus for the staff of the department while the unit transitions from semi-private to private patient care rooms.