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.