Involving patients in shift handoffs may reduce errors

Bedside shift changes make patients feel more engaged, informed

Including patients in nursing handovers may go a long way toward reducing medical errors and improving outcomes, as well as enhancing the patient experience, according to a study in the Journal of Nursing Care Quality. (See the Advisory Board's take on this study.)

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"The start and end of a nurse's shift are critical moments," says lead author Lianne Jeffs, a volunteer association chair in nursing research at St. Michael's Hospital in Toronto. Traditionally, nurses have relied on tape recordings or verbal briefings at nursing stations to share pertinent patient information between shifts, including clinical conditions, allergies, and care plans.

However, the latest study—which involved qualitative interviews with 45 patients—found that bedside handovers allow patients to ask questions with both nurses present, which may alleviate anxiety and boost satisfaction. Study participants described the handoffs as engaging, personal, and informative—but noted that providers should be sensitive to patients' preferences, which can vary over time.

"Having handover take place at the bedside with patients is better for everyone, but especially for our patients," Jeffs says. "It means they have a voice, better understand their treatment, and are engaged in their care."

St. Michael's nurses also indicated that bedside handover is more efficient and effective from their perspective. Since 2011, nurses on every medical and surgical unit of the hospital have performed handovers at their patient's besides.

"When we did handover at the nursing station, we had to begin prioritizing our patients' care before we'd ever met them," says Terri Irwin, St. Michael's professional practice leader in nursing, adding, "By seeing patients right away, nurses can assess all their patients' conditions and prioritize care within the first 15 minutes of our shift" (Budryk, FierceHealthcare, 11/21; ScienceDaily, 11/20).

The Advisory Board's take

Kate Vonderhaar, Nursing Executive Center

It's great to see new evidence demonstrating the power of bedside handovers. Whatever you call it—bedside handover, joint bedside report, or bedside shift handoff—it's a best practice we've come back to over and over again in our research because of its powerful impact on outcomes: patient experience and quality measures, not to mention peer accountability.

But even though bedside shift report is the right answer for patients and nurses, it's been awfully hard to engrain in nursing practice. Nurses worry that involving patients in shift report will take more time, and they wonder how to protect a patient's privacy if visitors are in the room during shift change. 

Yet organizations that have successfully transitioned to bedside handovers say that it takes the same amount of time as traditional handoff methods, and to address HIPAA concerns, nurses can simply ask patients who they would like present during handovers.

But don't take my word for it—hear from two nurse managers at Baylor Medical Center at Irving who've seen great success from implementing joint bedside report in their units. And if that's not enough, sign up for our upcoming webconference to learn how Orange Regional Medical Center standardized bedside handovers using the Nursing Executive Center's Joint Bedside Report Template.


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