Structured Bedside Handoffs Benefit Patients, Nursing Staff

Bedside handoffs between nurses are useful in relaying information to collaborative or subsequent healthcare providers at the point of care.

In addition, when done optimally, bedside handoffs involve the patient, which can lead to greater understanding of the plan of care, health status, medication list, and discharge plans. Patients also may feel an increase in respect from healthcare providers.

Nurses who participate in bedside handoffs have reported perceptions of improvement in staff communication and collaboration and noted an increase in team-based decision making. Nurses also have reported perceptions of increased accountability, improvement in patient safety, and reduced medical errors. In addition, bedside handoffs may improve chart documentation and promote continuity of care.

A group of nurse researchers led by Carlin Callaway, RN, DNP, NP, from the University of Colorado Cancer Center in Aurora, designed a study to evaluate bedside handoffs, the teach-back method, and discharge bundles on an inpatient oncology unit at a large military treatment facility. Patient activation scores, readmission rates, staff satisfaction, and anecdotal feedback from patients and nursing staff were collected prior to and following implementation of a multifaceted approach incorporating all 3 elements of the handoff protocol.

Methods

The teach-back method is well known to most nurses, and involves patients verbally repeating and explaining what has been taught to them. As patients describe their understanding of the healthcare plan, the nurse teacher can correct any misunderstandings and fill gaps in the patient’s understanding. The teach-back method has been associated with reduced readmission, and also enhances the patient’s participation in their own care.

Discharge bundles refer to patient education tools that are designed to collectively increase a patient’s understanding of self-care at home, and can include medication lists, checklists, and advanced care planning information. Ideally, discharge bundles are implemented upon hospital admission, used throughout the patient’s stay, and reviewed at the time of hospital discharge.

Patient engagement refers to actions that patients take to manage their health regardless of where they are (e.g. hospital, home). Involving patients in their own care may reduce injuries, such as those as a result of falling, and reduce or prevent errors. For example, well-informed patients who are familiar with their medications are better able to detect a dose or drug error.

Results

The patient activation surveys were completed by 49 patients with cancer before implementation of the protocol, and 71 completed the patient activation surveys after implementation. The average Patient Activation Measure (PAM)—a 13-item self-report on knowledge, skill, and confidence in managing the patient’s own health—before and after implementation were not significantly different (73.2 vs. 68.35), indicating that patients were active in self-care.

The nursing satisfaction survey was completed by 33 nurses before implementation of the bedside change-of-shift report, and 32 of them completed it after implementation. Staff satisfaction trended toward improvement on all 10 items after implementing the bedside change-of-shift report system. The readmission rate decreased from 32% to 25% during the study period, most likely due to implementation of the discharge “bundles” (detailed take-home educational materials) followed by use of the teach-back method.

The study findings, published in the Clinical Journal of Oncology Nursing, suggest that having a consistent, structured discharge protocol enhances staff satisfaction and may reduce hospital readmissions.