“The Joint Commission has identified communication as the top contributing factor to medical error, with handoffs playing a role in an estimated 80% of serious preventable adverse events.

– The Joint Commission

A Stronger Culture of Patient Safety is Achievable

The assurance of quality and safety is the single most significant responsibility of leaders in healthcare delivery. It’s a cornerstone of our careers. The hand-off process is pivotal to patient safety and many breaches of patient safety occur around change-of-shift.

Most hospitals have adopted some level of bedside handover by now, but telling nurses to give a report at the bedside doesn’t reduce unnecessary variation. Every nurse has their own way of giving report and nursing handover is typically inconsistent and unstructured.

Structured, Nurse-Designed Communication is Better

Acute care today is complex. But quality in complex systems is never the default. It must be designed. The best tools simplify what’s complex, without losing detail.

Structure by itself is not enough. The SBAR or “handover” screen in an EMR has a structure, but it’s far from an ideal tool. Nurses are practical, we only want stuff that works. That’s why any tool deployed across a hospital needs a pedigree- years of thoughtful iteration, tested and refined by thousands of nurses across hundreds of units.

Standardized, Patient-Centered Communication is Safer

 

Errors arise from unnecessary variation. Standardized communication is the answer. The literature is clear: To reduce patient harm, we want to use the same tool for each bedside handover.

Here’s what’s worked for us:

First, Structure the Bedside Handover Form

The form we use on our units follows familiar ISBAR and Systems Review formats and has been rigorously tested and refined hundreds of times. It’s not a script — nurses don’t like that — but it is a time-tested structure that aligns every nurse with a common shared mental model of what’s essential to report, and in what order.

“Other ways of doing nursing report make you feel like a robot. For the last 10 years, we’ve used another strategy out there on the market. But it was so scripted. ‘You need to say this, this, and this in a certain order.’ We lost sight of being ourselves and being real to the patient.  … This bedside handover report provides us with an awesome way of keeping us on task with what we should be reporting and involving the patient with each and every day.” -Amy, Unit Nurse Manager

For an example of what thoughtful structure looks like, consider the Nursing Quality Safety Checklist designed by our hospital Quality Improvement (QI) experts:

This structure wraps six separate QI projects into one efficient checklist.

When rolled out across a hospital, this checklist hardwires twice-daily moments to highlight potentially preventable complications for every patient in each participating unit — and a third time with a physician if used during Structured Interdisciplinary Bedside Rounds.

Next, Standardize the Bedside Handover Delivery

On our units, every unit in the hospital starts with the same standard ISBAR form, and then gets shoulder-to-shoulder help customizing it to reflect the needs of their patient population. In that way, every nurse on the unit uses the same form, and even float nurses see only small differences between units.

To make it stick, every nurse is trained in the same efficient way and assessed with a standard set of 9 high-performance behaviors to achieve Bedside Handover Excellence.

There’s great power in beginnings.

Change the first 20 minutes of each shift,
and you change the culture of your unit

Team Huddle

Our nurses didn’t feel like a team and started each shift more like a group of individuals running around. So we began a Change of Shift Huddle which takes 3 minutes. The off-going charge nurse reads through a standard form to the oncoming shift. It’s the most professional, efficient team meeting you’ll see anywhere in the hospital and starts with a 1-page form. You can use ours. Tens of thousands of nursing shifts have used it.

Bedside Handover

As nurses, we dread getting bad handoff. When there’s no structure, each nurse gives report their own way and it feels less safe and more stressful.

So our units decided to standardize each bedside handover. The heart of our handover is a structured, single-page shift report form using an ISBAR framework, Review of Systems outline, and it’s customized for the unit. It’s presented top to bottom by the outgoing nurse, then handed over with our patient.

Safety and Quality

The assurance of quality and safety is the single most significant responsibility of leaders in healthcare delivery. It’s a cornerstone of our careers.

The hand-off process is pivotal to patient safety. Many breaches of patient safety occur around change-of-shift. Most hospitals have adopted some level of bedside handover by now, but telling nurses to give report at the bedside doesn’t reduce unnecessary variation. Every nurse has their own way of giving report and nursing handover is typically inconsistent and unstructured.

Patient Satisfaction

High patient satisfaction scores are achievable and it’s a natural result of hardwiring a daily “wow moment” for each patient.
HCAHPS scores are driven by “top box” positive responses, but it’s hard to impress every patient every day. Asking stressed-out nurses to also be “customer service agents” isn’t the best approach.

Nurse Engagement

We’re living in a new era. Hospital nursing is more complex than ever and 50% of bedside nurses now say they’re burnt out. Turnover rates are spiking. Nurses choose hospitals that find meaningful ways to care for them, and we leave the ones that don’t. They prefer hospitals that:

-Reduce stress
-Help them get familiar with patients as quickly as possible
-Reduce unnecessary variation in communication
-Make them feel part of a high-performing team
-Have a collaborative work culture