Nathan Anthony Barfield, DNP, MSN, MBA, NE-BC, CPHQ, CNRN

Abstract:

Background: In response to the Joint Commission’s 2006 National Patient Safety Goal aimed at improving communication and handoffs in patient care, many healthcare organizations have adopted bedside shift reports. The Agency for Healthcare Research and Quality developed an evidence-based resource, the Nurse Bedside Shift Report Implementation Handbook and Checklist, that organizations can use to implement a standardized handoff practice. Despite the benefits of bedside report, many healthcare organizations have encountered challenges with its implementation and sustainment due to barriers such as time constraints, privacy concerns,  interruptions, and distractions. Objectives: The Doctor of Nursing Practice Scholarly Project aimed to evaluate the effectiveness of implementing a modified bedside shift report in a critical care setting using both qualitative and quantitative methods. The project aimed to implement a modified bedside report where information was exchanged outside the patient’s room, and essential safety updates and introductions occurred at the bedside. This approach aligns with emerging evidence that supports safety goals while addressing nurse and patient concerns about bedside reports, offering a practical path to sustaining effective handoffs and improving care transitions. The Agency for Healthcare Research and Quality bedside report checklist was modified to support a two-part handoff process. Methods: Thirty pre-/post-observations of the handoffs were completed. A pre- and post-survey consisting of 38 questions was completed to gain a better understanding of nurses' perceptions regarding whether a modified bedside report could serve as an alternative to a full bedside report. Independent sample t-tests were conducted to compare pre- and post-implementation survey responses on a five-point Likert scale. Results: Nine survey items demonstrated statistically significant improvements following implementation. Notably, consistent completion of the unit’s standardized shift handoff process, nurse satisfaction with the handoff process, and nurses electing the modified handoff process over the full bedside report. Qualitative data collected through open-ended survey responses, one-on-one interviews, and focus groups were analyzed using a thematic analysis approach. Recurring themes included barriers such as interruptions, language barriers, time constraints, and privacy concerns. Conclusion: The findings support the adoption of a modified bedside report as a nurse-driven, patient-centered approach to shift-to-shift care transitions, aligning with organizational goals for improved communication, workflow efficiency, safety, and nurse satisfaction. These results highlight both the value and challenges of standardizing handoff practices in a high-acuity environment, offering a framework for sustainable implementation.

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