Bedside Report

Overcoming Barriers to Maximize Benefits

Imagine being in the hospital and placing your life in the hands of strangers. Now imagine that hours have gone by since the shift change, and you have not seen anyone. It’s a busy day on the unit; they are short-staffed. You need help but have no idea who your nurse is or when they are coming to take care of you.

If the unit used bedside report, your previous nurse would have introduced you to the oncoming nurse. You would know the plan for the day. Even in a short-staffed environment, you would be confident someone would be there to meet your needs.

Benefits for Patients

There are many ways bedside report benefits patients, including better outcomes and better experience. It’s safer too.

Shift report at the nurses' station involves extended periods when patients are left alone. Sentinel events, defined by the Joint Commission as "resulting in death, permanent harm, or severe, temporary harm,” are more likely to happen during this time than any other part of the shift.[1],[2]

Handoff in the patient's room eliminates this alone time. Rates of sentinel events and falls go down.3 And patient satisfaction goes up,[1] according to research.

When patients participate in report, it’ s even better. They can share symptoms and changes. It is also an opportunity for teaching.[2] Research shows that high-quality education and engagement are critical to improving outcomes.[3],[4]

Benefits for staff

There are staff benefits too. Though it can be challenging to use bedside report, nurses have higher satisfaction scores when they do.[3] It also helps staff communicate, leading to fewer errors and less rework.[3]

Benefits for facilities

With bedside reporting, the improvement in patient experience naturally leads to improvements on HCAHPS surveys. Better communication reduces legal costs resulting from errors and events, research shows. And when implemented well, bedside report also leads to less paid overtime.[5]

Overcoming barriers

Despite many documented benefits, some hospitals struggle to use bedside report consistently.

It can be challenging to track down everyone you need to get report from if they are in rooms. Once the oncoming nurse is in the room, they can get tied up if the patient has needs, slowing down the rest of the handoff.

There are also privacy questions.[6] The next nurse may need to know things that are awkward to discuss in front of the patient. Social factors exist that staff need to handle with sensitivity. There may be situations the patient does not want reminders of, such as a traumatic event or loss.

Ways to overcome barriers and maximize report efficiency:

Split it up. Discuss sensitive topics in a brief, private report outside the room.
Create privacy. Close the unit to nonessential visitors during handoff.
Set expectations. Let the patients know you will address non-urgent needs shortly after report. Round with all patients afterward.
Try an offset shift change. Have nursing aides give handoff 30 minutes before nurses, so a team will be available to take care of patient needs during nursing report.
Consider a team-care model. Assign a nurse and one or more aides as a team to care for a group of patients. With a team, it is more likely someone will be available to meet patient needs.
Try consolidating. While not always possible, handing off a set of patients between two nurses makes report more efficient. Consolidate assignments as much as possible, while considering patient acuity and nurse skills.

With creativity, you can take advantage of the benefits of bedside report for patients and staff. As result, patients will have a better hospital experience, and your HCAHPS scores will improve too.

References:

[1] McAllen, E.R., Stephens, K., Swanson-Biearman, B., Kerr, K., Whiteman, K (April 9, 2018) "Moving Shift Report to the Bedside: An Evidence-Based Quality Improvement Project" OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 2

[2] Gregory S, Tan D, Tilrico M, Edwardson N, Gamm L. Bedside shift reports: what does the evidence say? J Nurs Adm. 2014;44(10):541-545. doi:10.1097/NNA.0000000000000115

[3] Bailey SC, Fang G, Annis IE, O’Conor R, Paasche-Orlow MK, Wolf MS. Health literacy and 30-day hospital readmission after acute myocardial infarction. BMJ Open. 2015;5(6):e006975. doi:10.1136/bmjopen-2014-006975

[4] Baker DW. Health literacy and mortality among elderly persons. Arch Intern Med. 2007;167(14):1503. doi:10.1001/archinte.167.14.1503

[5] Sherman J, Sand-Jecklin K, Johnson J. Investigating bedside nursing report: a synthesis of the literature. Medsurg Nurs. 2013;22(5):308-312, 318. https://pubmed.ncbi.nlm.nih.gov/24358572/

[6] Malfait S, Van Hecke A, Van Biesen W, Eeckloo K. Is privacy a problem during bedside handovers? A practice-oriented discussion paper. Nurs Ethics. 2019;26(7-8):2288-2297. doi:10.1177/0969733018791348