Standardized Bedside Shift Report and Patient-Nurse Communication Scores as Measured by HCAHPS

Purpose: A quality improvement (QI) project implemented on an inpatient cardiac unit evaluated the effectiveness of standardized bedside shift report (BSR) on patient-nurse communication scores as measured by CMS HCAHPS, which is part of the national public system reporting patient perceptions of hospital care1. Because communication for ambulatory care transitions begins at the patient’s bedside, the QI project encompassed this foundational setting to improve patient safety and satisfaction.

Review of literature: Improving nurse-patient communication can improve patient outcomes and satisfaction. Miscommunication between nurses and patients has contributed to ongoing patient safety issues in both the inpatient and ambulatory care settings. The Joint Commission (TJC) reported the most common cause of sentinel events is handoff communication failure2. Communication breakdown contributes to countless patient deaths. The Institute of Medicine reported between 44,000 and 98,000 patients die annually from preventable medical errors3. Nurses report difficulty with effective communication secondary to frequent interruptions, complex tasks, and inconsistencies with staffing and time limitations4. These factors can lead to omission of pertinent patient information and flawed transfers, ultimately compromising patient safety4. Effective and efficient communication is essential to provide quality patient care4. In accordance with TJC, standardized BSR is an evidence-based approach to improve inconsistencies and efficiency in patient handoff2. Evidence-based toolkits were used in the development of this project to directly engage nurses and patients in the education and implementation of standardizing patient handoff through BSR. Research shows involving patients during handoff decreases communication failures and duplication of care, thus improving patient outcomes and safety2. In addition to inpatient communication, primary care physicians are concerned with the transitions from inpatient to the ambulatory care citing omissions and delays leading to the potential of patient harm6.

Methodology: Patient handoff is an opportune time to improve nurse-patient communication, thereby contributing to positive patient outcomes. The QI project integrated the knowledge that communication directly affects patient safety and sentinel events. Using the Agency for Healthcare Research Quality bedside shift report toolkit and a five-step cyclic process, this QI project directly engaged both nurses and patients in the education and implementation processes to standardizing patient handoff through bedside shift report. The project also addressed potential barriers to bedside shift report and how to overcome these conflicts.

Analysis: Results were collected and analyzed through the CMS HCAHPS score reporting system. This system is a part of the national, standardized public reporting system that credibly and confidentially reports patient perceptions of hospital care.1 HCAHPs scores are sent to randomized patients regardless of insurance or reimbursement method.1

Results: Three months of post-data were collected and compared to pre-implementation scores (n=16). Post-data results showed an increase in nurse-patient communication scores with implementation of BSR. Results will be discussed.

Learning outcomes: Nurse leaders have a responsibility to continue identifying evidence-based strategies to optimize patient safety and quality care. Implications for practice stem from the use of toolkits to assist with development of efficient, sustainable, and quality handoff reports that establish effective communication between nurses and patients in all settings5.