Bedside handoffs boost patient satisfaction

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 shift-change 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.”