Improving Patient Satisfaction by Using Face-to-Face Beside Nursing End-of-Shift HandoffsRoland Ragan, RN; Mary Williamson, RN, BSN ; Matt Nusbaum, RN, BSN, CCRN, PCCN; Johanne Butler, RN;

Christina Sadowski, RN, BSN; Nathan Baughman, RN; Stephanie Hunt, RN, BSN, PCCN; Keith Hampton, MSN, APRN, ACNS-BC; and Douglas S. Wakefield, PhDBackground: Effective nursing change

of shift handoffs are essential for high quality and safe care. Our traditional nursing end-of-shift handoff process requiring nurses to record and listen to taped summaries, and review of notes in a Kardex, resulted in little time in direct nurse to nurse communication, and no direct involvement of the patient. Switching to face-to-face end-of-shift handoffs of nurses at the patients’ bedsides was seen as a way to enhance communications and patient satisfaction.

Objectives: Evaluate the effectiveness of nursing end-of-shift handoffs conducted at the patient’s bedsides in improving communications and patient satisfaction in a 20 bed Adult Step-Down Unit.

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Positively Received by

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Figure 4: Post Implementation Bedside Face-to-Face End of Shift Handoff Distribution of Nurse Perceptions (N=24): Part I

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Results: Patient satisfaction for specific nursing related patient satisfaction questions increased from 20th-40th percentile range to the 95th percentile following implementation (Figure 3). These gains have been maintained for all but three months since implementation. Nurses’ perceptions about the change were also positive (Figures 4 and 5).

Conclusion: Face-to-face end-of-shift nurse handoffs at patients’ bedsides was positively received by patients and nurses. A disciplined approach contributed to the success of this project.

Figure 5: Post implementation survey

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"Nurse to Nurse communication has improved at change of shift"

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*Figure 3: Mean Percentile Ranking for 150-299 Bed Category for Baseline Data (Jan-June 2009) and Post

Implementation (July 2009-Oct 2010) of Bedside Report

Mean 150-299 Rank Jan-June 2009Mean 150-299 Rank July 2009-Oct 2010

*Based on Press Ganey data analysis November 16, 2010

Specific Goals:•Improve effectiveness of communication among nurses (2009 NPSGs)•Improve patient satisfaction to the 90th percentile of peer institutions.Evaluation Methodology:

•Pre-post implementation patient satisfaction.•Pre-post nurse surveys of : 1) perceptions of the effectiveness of traditional nursing end-of-shift handoff process; and 2) attitudes towards the potential implementation of a face-to-face handoff conducted at the patient’s bedside.

Intervention: A structured face-to-face nursing handoff process conducted at the patients’ bedsides. Figures 1 and 2 present the traditional and intervention handoff processes.