AJN, American Journal of Nursing:
Making a commitment to quality.
In my first job on a critical care unit at a busy urban hospital, RNs and nurse's aides coming on duty received shift reports during walking rounds with the charge nurse of the outgoing shift. On the medical–surgical floors, nurses going off duty gave report to their head nurse, who in turn reported to the incoming head nurse, who then reported to her staff. At another facility, all outgoing RNs gave report to all incoming RNs (aides weren't included) at the same time at the nurses' station. And on the units that practiced primary nursing, outgoing primary nurses audiotaped reports; their incoming counterparts listened to the tapes but rarely interacted with the nurses going off duty, although they had that option. These four methods for giving shift report shared two similarities. First, none was based on evidence demonstrating its effectiveness over any other. And second, none specified what patient information was to be included; that critical aspect was left up to the individual giving the report.
It's been well documented that poor communication during patient handoffs is a major contributor to medical errors. Indeed, since 2008, the Joint Commission has required that hospitals have a standardized approach to handoffs. But is there evidence supporting one approach over another?
In this issue, Lee Ann Riesenberg and colleagues from the Christiana Care Health System in Newark, Delaware, report the results of their systematic review of research regarding nursing handoffs, which seeks "to identify features of structured handoffs that have been shown to be effective." While the authors conclude that most of the studies they reviewed lacked rigor and call for higher quality research in this area, they did identify and categorize numerous barriers to and strategies for effective patient handoffs. These thought-provoking categories suggest several areas for further inquiry.
Patient handoffs are fundamental to the delivery of safe care. Surely it's within nursing's purview to study and improve the handoff process. Of course, this is just one of many areas being investigated by clinicians and institutions as part of evidence-based quality improvement (QI) efforts. AJN has published several reports on QI projects, notably in our Transforming Care at the Bedside series (September 2008 through August 2009) and more recently in our Cultivating Quality column. (We welcome manuscripts about QI projects, but require that they follow the Standards for Quality Improvement Reporting Excellence [SQUIRE] guidelines, available at www.squire-statement.org.)
In that spirit of commitment to evidence-based practice, I'd like to introduce the newest member of AJN's editorial team. Jane Barnsteiner, PhD, RN, FAAN, joins us as our editor for translational research and QI. Most recently the director of nursing for translational research at the Hospital of the University of Pennsylvania in Philadelphia, Jane has a strong clinical background built on integrating research and education into practice. She also brings significant editorial acumen—she was the founding editor of the Online Journal of Knowledge Synthesis for Nursing. She'll solicit QI reports and original research with relevance for AJN's readership, manage the peer review process, and consult with authors and editors before and during the editing process.
Both in print and online, AJN disseminates information to clinicians working in a wide range of settings and specialties. Our mission is "to promote excellence in nursing and health care through dissemination of evidence-based, peer-reviewed clinical information and original research." In adding Jane Barnsteiner to our editorial team, we reaffirm that commitment to you.