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.' ”