The most crucial half-hour at a hospital: The shift change

Hospitals are transforming the traditional way nurses change shifts to reduce the chance of errors and oversights in the transfer of information. A critical side effect: patients feel safe, included and satisfied.

Studies show that so-called bedside shift reports, with both nurses meeting in the presence of the patient during the handover, help nurses communicate better, not only with each other but with patients and their families. Studies show the approach helps reduce the number of patient falls and catch safety issues such as an incompatible blood transfusion and dangerous air bubbles that form in arteries.

“Conducting nurse change-of-shift report at the bedside with the patient and family should be viewed as a core safety strategy in hospitals today,” says Beverley Johnson, chief executive officer of the Institute for Patient-and-Family-Centered Care, a nonprofit group based in Bethesda, Md., which offers webinars for hospitals on adopting bedside shift reporting. “It is a very tangible way to ensure that complete and accurate information is shared and there is mutual understanding of the care plan and other priorities.”

It is a big change from the traditional shift change in many hospital units, where nurses going off duty typically confer in a hallway or at the nursing station with the nurse coming on for the next shift, giving a rundown of their patients’ status and needs. In some cases nurses may simply write up a report in the medical record for the next shift to read.

But that critical information may be missed during shift changes. When nurses aren’t in the room for the handover, patients not only fall more often but also may have problems with intravenous lines or urinary catheters. And there is no opportunity for patients and family members to ask questions, state concerns or convey their own goals.

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In contrast bedside reporting helps improve patients’ ratings of their hospital experience at a time when Medicare is linking some payments to quality measures including how well hospitals score on patient satisfaction surveys.

Bedside reporting has met with some resistance on nursing units because of concerns that it would take up too much time and put nurses in danger of violating patient confidentiality. But patient advocacy groups say privacy rules should not be a barrier, as long as patients are told conversations may be overheard and asked about issues they would prefer to remain private. The groups say patients should have the option to designate which family members can be present.

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