The benefits of bedside reporting include patients' increased knowledge of their condition and treatment, improved patient and family satisfaction, and increased teambuilding between staff. These anticipated benefits from a quality, safety, and service aspect drove Catholic Healthcare West's (CHW) decision to move to a more patient-involved model of shift-to-shift nurse reporting.
Time for change
Through patient satisfaction surveys, CHW gathered feedback about its staff and overall hospital care. Patients noted that nurses weren't spending enough time with them or thoroughly informing them of medical conditions.
CHW reviewed the survey results and decided it was time to adopt a new model of patient care. After much research, the organization determined that its new program must include hourly rounding, individualized care, bedside reporting, and discharge phone calls. Bedside reporting became a main focus.
The benefits of bedside reporting are numerous and include increased patient involvement and understanding of care, decreased patient and family anxiety, decreased feelings of “abandonment” at shift changes, increased accountability of nurses, increased teamwork and relationships among nurses, and decreased potential for mistakes.1
Shift change was included in The Joint Commission's 2009 National Patient Safety Goals, which requires that shift hand-offs must include up-to-date information about the care, treatment, current condition, and recent or anticipated changes in the patient.2
Bedside reporting addresses The Joint Commission's Goal 13, a safety strategy that encourages the patient's active involvement in care.
Reports in action
A systemwide approach to bedside reporting was implemented at CHW due to an overwhelmingly positive response to a patient satisfaction presentation at the CHW Conference in 2005. Based on this response, the corporate office developed a series of CHW nurse manager training camps (held in January and August 2006), which included presentations from managers within CHW who had already implemented bedside reporting. Hospitals were provided with implementation plans, bedside shift report guidelines, and an SBART (situation-background-assessment-recommendation-thanks) communication tool for staff to use (Table 1).
Throughout 2006, the director of service excellence visited various hospitals to serve as a resource to validate the effectiveness of the implementation of bedside reporting. It was noted that there were a variety of techniques used to educate staff, ranging from a review of the policy, a review at staff meetings, or 1-to-2 hour classes. Lacking consistent education, staff members couldn't articulate the reasons behind bedside reporting. To help create a more fluid training program, “CHW World Tour—The Nursing Bundle” was born. This 4-hour class covers all elements of the nursing bundle, including bedside reporting, and is provided monthly at various locations in California, Arizona, and Nevada. Information about research and methodology from literature and CHW-specific results is provided. The class also focuses on “WIIFM” (what's in it for me) and allows for role-playing and questions. The CHW World Tour began in March 2007 and is still alive today. The class is updated yearly with new information and, to date, over 6,000 nurses have participated.
Validation through observation and patient rounding was used to ensure staff members' continued competency and practice. This allowed the nurse leader to coach, develop, and praise role models. Nurse leaders were also observed in the art of coaching to ensure that they were providing accurate feedback.
The CHW corporate office was also educated regarding the implementation of the nursing bundle and took an active interest in it. The regional vice-presidents asked for monthly updates on the program's progress. Recently, during an instructors meeting, the CEO of CHW interrupted the group, profusely thanking them for the positive impact they had throughout the organization, and congratulated them on the number of nurses they had taught.
Bedside reporting has made incredible progress at CHW regarding patient satisfaction. The success was measured by the hospitals' nurse leadership group's rounds and through the use of patient satisfaction scores (Figures 1–3). Topics monitored on the survey include:
- The nursing staff spent the right amount of time with me.
- The nursing staff helped me to understand my health condition.
- The nursing staff kept me informed of my daily condition.
Now, during a bedside report, patients may include information not previously shared, ask questions, and thank the nurses for spending the time to discuss what's going on. One patient said, “I just love it when the nurse leaving and the nurse starting come in and the three of us have a little chat about me! I learn so much.”
From a quality of care standpoint, there have been numerous incidences documenting dramatic interventions based on a patient's change of condition during bedside reporting. One incident involved a drop in respirations; the two nurses switching shifts were able to quickly stabilize the patient. Had the nurses done a traditional shift report, away from the patient, the outcome would have been very different.
Instituting bedside reporting allows nurses to positively impact patient and family experiences. It puts patients at the center of communication and permits them to collaborate and participate in their own recovery. Bedside reporting encourages teamwork and accountability of staff and is safer for the patient because it increases the quality of hospital care.