Patient Services/Patient Satisfaction/Bedside Nurse Shift Reports/BESt 170

Best Evidence Statement (BESt)

Date: August 12, 2013

Title: Increasing Patient Satisfaction by Moving Nursing Shift Report to the Bedside

Clinical Question:
P (Population/Problem) Among patients and families
I (Intervention) does implementation of bedside nurse to nurse shift report
C (Comparison) versus a non-bedside nurse to nurse shift report
O (Outcome) increase patient/family satisfaction during hospitalization?

Target Population for the Recommendation:

Inclusion criteria: All hospitalized patients; if under age of 18, with caregiver present.
Exclusion criteria: Patients/Parents electing not to participate.
Recommendation:
It is recommended that nurses perform bedside shift to shift report, to increase patient/family satisfaction (Maxson,
Derby, Wrobleski, & Foss, 2012 [4a]; Radtke, 2013 [4a]; Sand-Jecklin, Sherman, 2013 [4a]; Tidwell et al., 2011 [4a];
Thomas, Donohue-Porter, 2012 [4b]).
Discussion/Synthesis of Evidence related to the recommendation:
The grade for the body of evidence was moderate. Five of the six studies used a descriptive design (Maxson, Derby,
Wrobleski, & Foss, 2012 [4a]; Radtke, 2013 [4a]; Sand-Jecklin, Sherman, 2013 [4a]; Tidwell et al., 2011 [4a]; Thomas,
Donohue-Porter, 2012 [4b]), with the other being a systematic review of literature (Riesenburg, Leitzsch, & Cunningham,
2010 [1b]).
The systematic review of literature examined 55 studies in order to determine best practice related to nursing handoffs
and concluded that communication was the biggest barrier to an effective handoff (Riesenburg, Leitzsch, & Cunningham,
2010 [1b]). Additionally, standardized strategies and inclusion of the patient and family in rounds were noted as a key
factor in effective handoffs but no linkage to patient satisfaction was discussed (Riesenburg, Leitzsch, & Cunningham,
2010 [1b]).
Descriptive studies were conducted on med-surgical units with sample sizes ranging between 25 and 232 patients family
members (Maxson, Derby, Wrobleski, & Foss, 2012 [4a]; Radtke, 2013 [4a]; Sand-Jecklin, Sherman, 2013 [4a]; Tidwell et
al., 2011 [4a]; Thomas, Donohue-Porter, 2012 [4b]). Studies used Likert surveys for their outcome measures. Pre-
implementation and post implementation surveys were given to patient’s family members as well as nursing staff in
regards to satisfaction. Survey questions elicited feedback regarding patient/family perception around communication
and teamwork, safety, being a part of their plan of care, and satisfaction with the care provided (Maxson, Derby,
Wrobleski, & Foss, 2012 [4a]; Radtke, 2013 [4a]; Sand-Jecklin, Sherman, 2013 [4a]; Tidwell et al., 2011 [4a]; Thomas,
Donohue-Porter, 2012 [4b]). All studies reported an increase in patient/family satisfaction post implementation of
bedside nurse to nurse reporting; although no statistical significance was found, the results are clinically significant
(Maxson, Derby, Wrobleski, & Foss, 2012 [4a]; Radtke, 2013 [4a]; Sand-Jecklin, Sherman, 2013 [4a]; Tidwell et al., 2011
[4a]; Thomas, Donohue-Porter, 2012 [4b]). Other clinically significant results included a decrease in fall rates and
medication errors (Sand-Jecklin, Sherman, 2013 [4a]), as well as an increase in nursing satisfaction, and an overall
decrease in overtime leading to financial savings (Tidwell et all, 2011 [4a]).
Reference List:
Maxson, P., Derby, K., Wrobleski, D., & Foss, D. (2012). Bedside nurse-to-nurse handoff promotes patient safety.
Medsurg Nursing: Official Journal Of The Academy Of Medical-Surgical Nurses, 21(3), 140-144. Retrieved from
Medsurg Nursing: http://www.prolibraries.com/amsn/?select=publicationlist&resourceID=1 [4a]
Radtke, K. (2013). Improving patient satisfaction with nursing communication using bedside shift report. Clinical Nurse
Specialist CNS, 27(1), 19-25. doi:10.1097/NUR.0b013e3182777011. [4a]
Riesenberg, L., Leitzsch, J., & Cunningham, J. (2010). Nursing handoffs: a systematic review of the literature. The
American Journal Of Nursing, 110(4), 24-34. doi:10.1097/01.NAJ.0000370154.79857.09.[1b]

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 Patient Services/Patient Satisfaction/Bedside Nurse Shift Reports/BESt 170
Sand-Jecklin, K., & Sherman, J. (2013). Incorporating bedside report into nursing handoff: evaluation of change in
practice. Journal Of Nursing Care Quality, 28(2), 186-194. doi:10.1097/NCQ.0b013e31827a4795.[4a]
Thomas, L., & Donohue-Porter, P. (2012). Blending evidence and innovation: improving intershift handoffs in a
multihospital setting. Journal Of Nursing Care Quality, 27(2), 116-124. doi:10.1097/NCQ.0b013e318241cb3b.[4b]
Tidwell, T., Edwards, J., Snider, E., Lindsey, C., Reed, A., Scroggins, I., & Brigance, J. (2011). A nursing pilot study on
bedside reporting to promote best practice and patient/family-centered care. The Journal Of Neuroscience Nursing:
Journal Of The American Association Of Neuroscience Nurses, 43(4), E1-E5. doi:10.1097/JNN.0b013e3182212a1d.[4a]

IMPLEMENTATION
Applicability Issues:
Recommendation adherence will require the support of administration, unit managers, and nursing leaders to act as
champions of change. It will be important for this support team and nursing staff to understand and be able to
articulate the identified goals and outcomes to be achieved by implementing bedside nursing report to the nursing staff.
Creating a standardized reporting sheet, which will include a head to toe assessment report, electronic medical record
check, patient plan of care check, safety check, and introductory cues for communicating with the patient and family,
will support the implementation of this change. In addition, patient assignments should be allocated to the same nurse
if possible, to help with clustering report. Providing staff with adequate time to become accustomed to the new report
methods and also encouraging their feedback can help resolve issues and identify areas of concern and assist them in
the transition.
Relevant CCHMC Tools for Implementation:
CCHMC Policy number CPC-I-103: Safe Handoffs of Care
SG Form No. 100216: Authorization for Use and/or Disclosure of Limited Protected Health Information
Outcome or Process Measures:
Benchmark data can be collected quarterly in regards to patient satisfaction based on survey questions. With the
implementation of bedside nursing report, the goal would be to increase the patient satisfaction scores to meet these
benchmark measures since all could be affected by this change.
The charge nurse for each shift should be responsible for tracking if every nurse is participating in nurse to nurse bedside
report for families that choose this option.
A unit based survey can be used to measure patient/family satisfaction in regards to nursing report prior to change, for a
baseline, and then again after implementation of bedside report.
SUPPORTING INFORMATION
Background/Purpose of BESt Development:
In an attempt to meet the Joint Commission’s National Patient Safety Goals to improve staff communication, as well as
individual unit benchmark patient satisfaction goals in accordance with Magnet Certification, a search of the literature
was needed to find evidence to improve current report processes.
Search Strategy:
Databases: PubMed, Cochrane Library, CINAHL, OVID Medline
Search Terms: Nursing; handoff; shift report; patient satisfaction; bedside handoff
Limits, Filters: English language, Search dates: 2006- 2013
Date last searched: 2/26/13
Relevant CCHMC Evidence-Based Documents:
None were found
Group/Team Members:
Team Leader/Author: Sarah Barker, RN, BSN
Team Members: Kathleen Dressman RN, MS, Senior Clinical Director, TCC, A7C1 Complex Pulmonary; Deborah Warden
RN, BSN, Clinical manager, A7C1 Complex Pulmonary
Support/Consultant: Patti Besuner RN, MN, EBP Mentor, Center for Professional Excellence, Research, & Evidence Based
Practice

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 Patient Services/Patient Satisfaction/Bedside Nurse Shift Reports/BESt 170
Conflicts of Interest were declared for each team member:
No financial or intellectual conflicts of interest were found.
No external funding was received for development of this BESt.
The following conflicts of interest were disclosed:

Note: Full tables of the LEGEND evidence evaluation system are available in separate documents:
 Table of Evidence Levels of Individual Studies by Domain, Study Design, & Quality (abbreviated table below)
 Grading a Body of Evidence to Answer a Clinical Question
 Judging the Strength of a Recommendation (dimensions table below)

Table of Evidence Levels (see note above):

Quality level Definition
1a† or 1b† Systematic review, meta-analysis, or meta-synthesis of multiple studies
2a or 2b Best study design for domain
3a or 3b Fair study design for domain
4a or 4b Weak study design for domain
General review, expert opinion, case report, consensus report, or
5a or 5b
guideline
5 Local Consensus
†a = good quality study; b = lesser quality study

Table of Language and Definitions for Recommendation Strength (see note above):
Language for Strength Definition
It is strongly recommended that… When the dimensions for judging the strength of the evidence are applied,
It is strongly recommended that… not… there is high support that benefits clearly outweigh risks and burdens.
(or visa-versa for negative recommendations)
It is recommended that… When the dimensions for judging the strength of the evidence are applied,
It is recommended that… not… there is moderate support that benefits are closely balanced with risks and burdens.
There is insufficient evidence and a lack of consensus to make a recommendation…
Given the dimensions below and that more answers to the left of the scales indicate support for a stronger recommendation, the
recommendation statement above reflects the strength of the recommendation as judged by the development group.
(Note that for negative recommendations, the left/right logic may be reversed for one or more dimensions.)
Rationale for judgment and selection of each dimension:
1. Grade of the Body of Evidence High Moderate Low
Rationale: Multiple studies, weaker designs, consistent results
2. Safety/Harm (Side Effects and Risks) Minimal Moderate Serious
Rationale: Improved communication through bedside reporting increased accountability and a feeling of greater safety for patients
(Maxson, Derby, Wrobleski, 2012, [4a]).
3. Health benefit to patient Significant Moderate Minimal
Rationale: Patient outcomes of falls and medication errors decreased within a month of bedside reporting implementation (Sand-Jecklin,
Sherman, 2013, [4a]).
4. Burden on patient to adhere to recommendation Low Unable to determine High
Rationale: Patient’s families get to choose whether they want to be a part of bedside report
5. Cost-effectiveness to healthcare system Cost-effective Inconclusive Not cost-effective
Rationale: Bedside shift report was shown to decrease overtime by nurses (Riesenburg, Leitzsch, & Cunningham, 2010 [1b]).
6. Directness of the evidence for this target Directly relates Some concern of Indirectly relates
population directness
Rationale: Intervention applicable for all hospitalized patients
7. Impact on morbidity/mortality or quality of life High Medium Low
Rationale: Intervention has shown an increase in patient satisfaction and patient safety and promotes patient participating in their own
plan of care. Also has shown decreased medication errors and falls (Maxson, Derby, Wrobleski, 2012 [4a]).

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 Patient Services/Patient Satisfaction/Bedside Nurse Shift Reports/BESt 170
Copies of this Best Evidence Statement (BESt) and related tools (if applicable, e.g., screening tools, algorithms, etc.) are available online and may be
distributed by any organization for the global purpose of improving child health outcomes.
Website address: http://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/bests/
Examples of approved uses of the BESt include the following:
• Copies may be provided to anyone involved in the organization’s process for developing and implementing evidence based care;
• Hyperlinks to the CCHMC website may be placed on the organization’s website;
• The BESt may be adopted or adapted for use within the organization, provided that CCHMC receives appropriate attribution on all written or
electronic documents; and
• Copies may be provided to patients and the clinicians who manage their care.
Notification of CCHMC at [email protected] for any BESt adopted, adapted, implemented, or hyperlinked by the organization is appreciated.

Please cite as: Barker, S., Cincinnati Children's Hospital Medical Center: Best Evidence Statement Increasing Patient Satisfaction by Moving Nursing
Shift Report to the Bedside, http://www.cincinnatichildrens.org/svc/alpha/h/health-policy/best.htm, BESt 170, pages 1-4, 8/12/13.

This Best Evidence Statement has been reviewed against quality criteria by two independent reviewers from the CCHMC Evidence Collaboration.
Conflict of interest declaration forms are filed with the CCHMC EBDM group.

Once the BESt has been in place for five years, the development team reconvenes to explore the continued validity of the recommendation. This
phase can be initiated at any point that evidence indicates a critical change is needed. CCHMC EBDM staff performs a quarterly search for new
evidence in an horizon scanning process. If new evidence arises related to this BESt, authors are contacted to evaluate and revise, if necessary.

For more information about CCHMC Best Evidence Statements and the development process, contact the
Evidence Collaboration at [email protected].

Note:
This Best Evidence Statement addresses only key points of care for the target population; it is not intended to be a comprehensive practice
guideline. These recommendations result from review of literature and practices current at the time of their formulation. This Best Evidence
Statement does not preclude using care modalities proven efficacious in studies published subsequent to the current revision of this document.
This document is not intended to impose standards of care preventing selective variances from the recommendations to meet the specific and
unique requirements of individual patients. Adherence to this Statement is voluntary. The clinician in light of the individual circumstances
presented by the patient must make the ultimate judgment regarding the priority of any specific procedure.

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