bedsidereport.pdf

495Worldviews on Evidence-Based , 2019; 16:6, 495–497.
© 2019 Sigma Theta Tau International

Implementing EBP Column

Bedside Report: Handoffs Impact
Outcomes for Caregivers, Healthcare
Providers, and Organizations
Margaret A. Gettis, DNP, CPNP-PC ! Betsy Dye, MSN, RN, CPN ! Calvin Williams,
MSN, RN ! Brenna Frankish, MSN, RN, CPN ! Beverly Alvarez, BSN, RN, CPN

This column shares the best evidence-based strategies and innovative ideas on how to
facilitate the learning and implementation of EBP principles and processes by clini-
cians as well as nursing and interprofessional students. Guidelines for submission are
available at http://onlin elibr ary.wiley.com/journ al/10.1111/(ISSN)1741-6787.

BACKGROUND
A large pediatric healthca re org anization is undergo ing
transformation to align nur sing c are with scientific evi-
dence supporting its functi on (Ch ildren’s Healthcar e of
Atlanta, 2017). Nurses are gi ven opportunities to attend
evidence-based practice (EBP) academy to enculturate this
change. Recent participating nurses recognized the critical
importance of standardized transfer of care to impact pa-
tient safety. The management of the three hospital system
agreed no consensus existed about best practice for nurs-
ing report when transferring care to the next shift. Also
noted was a lack of family participation with the hea lth-
care team’s process.

Broad variation existed with transfer of care execu-
tion and reporting locations. Incoming nurses would
gather with outgoing nurses for change in shift report at
the nurses’ station, available computers, or open spaces.
Complicating things further, the sanctioned Situation,
Background, Assessment, Recommendation (SBAR) re-
porting tool was used inconsistently. Some reported using
the format, while others recalled the day’s events from
memory, the electronic medical record, or the personalized
sheets. leadership verbalized concern that critical
patient information could be missed, and private protected
health information could be overheard inappropriately. For
example, three general care units all employed different
methodologies. Average patient satisfaction scores in the
Hospital Consumer Assessment of Healthcare Providers
and Systems survey question, “How often did your child’s
nurse explain things in a way that was easy to understand,”
were 82.7%, 85.7%, and 87.3%, respectively. Scores to the
question, “the nurse listened carefully to the parent,” var-
ied from 84.6%, 89.1%, and 76.4%. Given the lack of stan-
dardized approach and potential relationship with nursing

satisfaction scores, alignment of bedside report was identi-
fied as a critical initiative across the system.

POPULATION INTERVENTION
COMPARISION OUTCOME
Academy nurses posed the question: “For pediatric pa-
tients and families, how does transfer of nursing care at the
bedside compared to current practices impact safety and
satisfaction?”

SEARCH STRATEGY
The nurses worked collaboratively, completing a literature
review. Databases searched are as follows: PubMed, CINAHL,
and OVID for the years 2010-2017 yielded 221 articles. Key
search terms were as follows: nursing report/handoff, care
transfer, multidisciplinary rounds, and bedside handover.
Refined searching used the following: nursing AND bed-
side AND report. Twenty-five articles selected represented
the current state of science. Nurses appraised each article,
synthesizing the evidence into a literature summary table.
The literature summary table and accompanying recommen-
dations for a new bedside shift report were communicated
to nursing leadership at a culminating event for academy
graduates.

CRITICAL APPRAISAL OF THE EVIDENCE
Identified by the Institute of Medicine, Joint Commission,
and the Agency for Healthcare Research and Quality (2013),
the evidence-based findings are clear: bedside shift report
is best practice using standardized reporting tools and for-
matting (Vines, Dupler, Vanson, & Guido, 2014). Uniform

Worldviews on Evidence-Based , 2019; 16:6, 495–497.
© 2019 Sigma Theta Tau International

496

Bedside Report: Handoffs

transfer of care at the bedside can decrease medication er-
rors, limit interruptions, and provide opportunity for the pa-
tient or family to correct misconceptions or misinformation
promoting patient safety (Mardis et al., 2015). According to
several studies, implementation of consistent care handoff
procedures can reduce overtime as nurses remain focused
solely on patients while giving the report (Carnes, Dudjak,
Hoffman, & Lorenz, 2013; Tidwell et al., 2011).

INTEGRATION OF EVIDENCE WITH
CLINICAL EXPERTISE AND PATIENT
PREFERENCES; CLINICAL DECISION AND
IMPLEMENTATION OF PRACTICE CHANGE
Academy nurses formulated the following recommenda-
tions to improve bedside shift report:

1. Perform bedside report between incoming and
outgoing nurses at each shift, executing transfer
of care utilizing SBAR reporting exclusively.

2. Modify SBAR reporting with “S” (sensitive-situa-
tion-social) and “B” (background) information
given outside the patient’s room in a private area.
Completion of “A” (assessment) and “R” (recom-
mendations) occurring inside the patient’s room
with patient or family present to share informa-
tion and answer questions.

3. Engage stakeholders and pilot the process on three
general care units at two hospitals.

IMPLEMENTATION
Prior to piloting, a survey was given on the units to assess
perceptions of current shift change reporting. Perceptions
were examined and discussed by unit leaders. Core teams
formed to role-play the new format allowing these mem-
bers to serve as role models to staff. Nurse forums allowed
staff to learn specifics about rollout, ask questions, and
practice the new reporting structure. The “Go Live” for unit
implementation started in May 2017. All nurses in the pilot
units began assimilating and executing the new process at
the bedside with EBP Academy nurses’ support and encour-
agement. These nurses were able to offer feedback about
successes and challenges to their colleagues in real time.
Based on feedback, the pilot was successful and rollout to
other units progressed smoothly.

OUTCOMES
leadership expected some resistance by clini-
cal staff to changes in transfer of care but was confident
families would be pleased with inclusion and participa-
tion in bedside report. Outcomes evaluation and postdata
collection began in September 2017. For the nurse “ex-
plaining” question, two units reported a 4.2% increase

and a 10.15% increase, while one unit reported a 3.09%
decrease. Concurrently, the nurse “listening” question on
one unit showed a slight 0.22% decrease, but two units
showed 3.07% and 20.8% increases. These improvements
validated to staff EBP initiatives can impact nursing trans-
fer of care and patient and family satisfaction. Ongoing
data monitoring by clinical leaders remains a priority to
address percentage decreases and minimize the likeli-
hood of practice drift, further hardwiring the practice
change (Harvey & Sotardi, 2017). Informal rounding at
change of shift reveals nurses engaging in care transfer
outside patient rooms and inside with families actively
participating.

DISSEMINATION
Besides publication, plans include poster entry in the or-
ganization’s EBP awards program highlighting nursing
projects. Winners are featured at an annual breakfast, and
posters are displayed within the hospitals showcasing to
patients, families, and community scientific methodologies
being employed by nurses to improve patient care. National
dissemination plans include poster and podium presenta-
tions at professional organization events. WVN

LINKING EVIDENCE TO ACTION

• Evidence demonstrates bedside shift report is consid-
ered best practice when using standardized reporting
tools/formatting.

• Patient safety can be improved by implementing evi-
dence-based transfer of care at the bedside. Engaging
nurses in EBP Academy and mentoring relationships
can bring importance of EBP to life.

Author information
Margaret A. Gettis, Nurse Scientist/Pediatric Nurse
Practitioner, Children’s Healthcare of Atlanta at Scottish
Rite, Atlanta, GA, USA; Betsy Dye, Clinical Educator,
Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA,
USA; Calvin Williams, Assistant Nurse Manager, Children’s
Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Brenna
Frankish, Clinical Educator, Children’s Healthcare of Atlanta
at Scottish Rite, Atlanta, GA, USA; Beverly Alvarez, Assistant
Nurse Manager, Children’s Healthcare of Atlanta at Scottish
Rite, Atlanta, GA, USA.

Address correspondence to Margaret A. Gettis, Children’s
Healthcare of Atlanta, 1649 Tullie Circle, Atlanta, GA 30329,
USA; [email protected]

Accepted 20 July 2019
© 2019 Sigma Theta Tau International

Worldviews on Evidence-Based , 2019; 16:6, 495–497.
© 2019 Sigma Theta Tau International

497

Implementing EBP Column

References
Agency for Healthcare Research and Quality. (2013). Strategy 3: Nurse bedside

shift report. Retrieved from http://www.ahrq.gov/profe ssion als/syste ms/
hospi tal/engag ingfa milie s/strat egy3/index.htm

Carnes, L., Dudjak, L., Hoffman, R., & Lorenz, H. (2013). Utilizing bedside
shift report to improve the effectiveness of shift handoff. Journal of
Administration, 43, 160–165. https ://doi.org/10.1097/NNA.0b013 e3182
83dc02

Children’s Healthcare of Atlanta. (2017). Nurses station, children’s profes-
sional practice model. Retrieved from https ://choa.caref orcec onnec tion.
org/commu nity/clini cal-care/nurses-stati on/nursi ng-practice

Harvey, H. B., & Sotardi, S. T. (2017). Normalization of deviance and practical
drift. Journal of the American College of Radiology, 14(12), 1572–1573. https ://doi.
org/10.1016/j.jacr.2017.08.003

Mardis, T., Mardis, M., Davis, J., Justice, E. M., Holdinsky, R., Donnelly, J.,
… Riesenberg, L. A. (2015). Bedside shift-to-shift handoffs: A systematic
review of the literature. Journal of Care Quality, 31(1), 54–60.

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. Journal of Neuroscience ,
43, E1–E5. https ://doi.org/10.1097/JNN.ObO13 e3182 21a1d

Vines, M. M., Dupler, A. E., Vanson, C. R., & Guido, G. W. (2014). Improving
client and nurse satisfaction through the utilization of bedside re-
port. Journal for Nurses in Professional Development, 30(4), 166–173. https ://doi.
org/10.1097/NND.00000 00000 000057

10.1111/wvn.12404
WVN 2019;16:495–497

Copyright of Worldviews on Evidence-Based is the property of Wiley-Blackwell and
its content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder’s express written permission. However, users may print, download, or email
articles for individual use.