Bed­side hand­offs boost pa­tient sat­is­fac­tion

Modern Healthcare - - BEST PRACTICES - By David Royse

Michelle Gray re­calls from her years as a crit­i­cal-care nurse that many pa­tients and their fam­i­lies had no idea what was go­ing on with their care. She re­al­ized that lack of in­for­ma­tion made be­ing in the hos­pi­tal even more stress­ful for pa­tients and could hin­der their re­cov­ery.

“A lot of times our pa­tients would come, get sent out, and won­der, ‘What in the world just went on?’ ” said Gray, now di­rec­tor of care trans­for­ma­tion at Emory Health­care in At­lanta.

Nearly a decade ago, she at­tended a con­fer­ence and heard about a new way some hos­pi­tals were try­ing to keep pa­tients and their fam­i­lies in the loop. She re­turned to Emory ea­ger to try it.

The con­cept was sim­ple but rep­re­sented a ma­jor break with stan­dard prac­tice. At shift change, the de­part­ing nurse and the nurse com­ing on duty meet to dis­cuss the pa­tient’s care with each other and with the pa­tient and the pa­tient’s fam­ily. They have that con­ver­sa­tion right in the pa­tient’s room rather than do­ing the “shift change han­dover” at a nurs­ing sta­tion or in the hall­way.

It took a couple of years to fully im­ple­ment the process change at Emory, but now it is stan­dard prac­tice at the sys­tem’s six hos­pi­tals. “Pa­tients and fam­i­lies just loved it,” Gray said.

She added that Emory now has sig­nif­i­cantly higher pa­tient-sat­is­fac­tion mea­sure­ments, which she at­tributes at least partly to the re­vised shift-change han­dover process.

Gray and other nurs­ing ex­perts who have stud­ied the con­cept say discussing the care plan with the pa­tient and fam­ily mem­bers at ev­ery shift change helps the pa­tient feel more a part of the heal­ing process.

Sim­ply hav­ing the nurses con­fer in the pa­tient’s room isn’t enough, stressed Bev­er­ley John­son, CEO of the Bethesda, Md.-based In­sti­tute for Pa­tient- and Fam­ily-Cen­tered Care, which trains nurses how to con­duct bed­side shift-change hand­offs. It’s es­sen­tial to con­duct the dis­cus­sion with the pa­tient and fam­ily mem­bers, not just in front of them. “Some­times nurses get the geography right,” she said, “but they’re still not do­ing it with the col­lab­o­ra­tion of the pa­tient and the fam­ily.”

In ad­di­tion, supporters say bed­side shift-change con­fer­ences can help avoid med­i­cal mis­takes, par­tic­u­larly med­i­ca­tion er­rors. “Ev­ery­body knows what’s go­ing on, and it helps elim­i­nate mis­com­mu­ni­ca­tion er­rors,” said Arvis Con­nolly, a nurse man­ager at the Univer­sity of Ver­mont Med­i­cal Cen­ter in Burling­ton, which started the prac­tice two years ago. “A fam­ily can chime in and say, ‘Don’t forget about this.’ ”

“It’s an ex­tra set of eyes and ears,” John­son said. “You can get ev­ery­body on the same page.”

Lit­tle re­search ex­ists on whether th­ese bed­side con­fer­ences re­duce er­rors. Emory, how­ever, is start­ing to mea­sure that, Gray said. Still, that’s not the main goal.

“The heart of it is we wanted to im­prove our pa­tient ex­pe­ri­ence,” Con­nolly said.

Like Emory, the Univer­sity of Ver­mont has got­ten fa­vor­able re­ac­tions from pa­tients and fam­ily mem­bers to the new process. Pa­tient-sat­is­fac­tion num­bers rose, and pa­tients who said on their dis­charge sur­vey that they were en­cour­aged to par­tic­i­pate dur­ing nurs­ing shift changes rated their sat­is­fac­tion the high­est. “Over­whelm­ingly, they have said they feel less anx­ious, more in­formed and safer,” Con­nolly said.

A study in the Jour­nal of Nurs­ing Care Qual­ity in 2013 backed up Emory’s and the Univer­sity of Ver­mont’s pos­i­tive ex­pe­ri­ences with bed­side nurs­ing hand­offs. It was based on in­ter­views with pa­tients at St. Michael’s Hos­pi­tal in Toronto, which started bed­side shiftchange meet­ings in 2010.

“The pa­tients ab­so­lutely loved the en­gage­ment,” said Lianne Jeffs, the study’s lead au­thor and di­rec­tor of nurs­ing/clin­i­cal re­search at St. Michael’s. “It really en­abled them to know what was go­ing on and be in­volved.”

The study also found that pa­tients thought that bed­side hand­offs pre­vented er­rors, mostly re­lated to med­i­ca­tion. “Sev­eral par­tic­i­pants de­scribed that they were able to iden­tify mis­takes and po­ten­tial er­rors dur­ing bed­side nurs­ing han­dover,” the au­thors wrote.

At both Emory and the Univer­sity of Ver­mont, nurses ini­tially pushed back. “Some peo­ple don’t like talk­ing in front of pa­tients and fam­i­lies,” Gray said. “They’re in­tim­i­dated.”

Con­nolly said it wasn’t easy for nurses to break from long-es­tab­lished ways. “Shift re­port has al­ways been done away from the pa­tient and fam­ily, and I think some nurses saw that as pro­tected con­ver­sa­tion time for them,” she said.

De­spite the early reser­va­tions, bed­side hand­offs have be­come the new nor­mal at both hos­pi­tal sys­tems. “I do think the nurses see the ad­van­tages,” Gray said. “They can more eas­ily set a goal where the pa­tient gets in­volved in get­ting bet­ter and get­ting out.”

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