1. Improving Nurse/Patient Communication During Bedside Care Handoff: A Performance Improvement Project
Project Progress Report
Katy Ridge, RN, BSN
Acute Care of the Elderly (ACE) Unit

2. Opportunity Statement
Bedside handoff has been the standard of care on our unit for several years, but there is no standard practice for involving the patient and family in the discussion
It is not known how much patient and family involvement is occurring during bedside report

3. Background
Improved staff communication is a Joint Commission national patient safety goal (
Bedside handoff has been found to increase accuracy of information (Tobiano, et al. 2013)
The Patient Protection and Affordable Care Act uses patient satisfaction surveys as part of the calculation for the value-based incentive payments to hospitals (
Bedside handoff has been found to increase patient and family satisfaction (Tobiano et al. 2012)

4. Purpose To measure the quality of RN bedside handoff
To monitor the frequency of RN bedside handoff
To improve communication, patient safety, and patient satisfaction
To improve staff readiness to assume care immediately following bedside handoff

5. Methods-Baseline Data Collection
Staff survey regarding perceptions and practice of bedside handoff
Patient interviews regarding bedside handoff and staff communication
Audits of EPIC documentation of bedside handoff
HCAHPS for responsiveness of hospital staff

6. Methods-Intervention
Bedside handoff video for staff education presented at staff meeting
Poster presentation of the process improvement project
and one-on-one sign-off of education on the LOOK Report Checklist w/ scripted questions for patient involvement
How is your pain?
What are your goals for today/tonight?

7. Methods-Post Intervention Evaluation
Staff survey regarding perceptions and practice of bedside handoff
Patient interviews regarding bedside handoff and staff communication
Audits of EPIC documentation of bedside handoff
HCAHPS for responsiveness of hospital staff

8. Instruments
The staff survey and patient interview were developed in consultation with the leadership team on the ACE unit. Many of the questions were adapted from previously published research studies on the same topic.
The EPIC documentation audit tool is the same used by other members of the handoff communications champions committee.
HCAHPS for “responsiveness of hospital staff” were taken for the time period 7/2013-1/2014

9. Pre-Intervention Data
HCAHPS for responsiveness of hospital staff for the time period 7/2013-1/2014 were:
Never 1.8
Sometimes 7.7
Usually 29.2
Always 61.3
EPIC documentation of bedside handoff for 1/2014 through 2/2014 was 94%

10. Pre-Intervention Data
Staff Survey

21. Pre-Intervention Data
Patient Interviews

22. Patient Interview Questions
Yes/No Questions
Did your nurses come into the room together at the last shift change?
Did the nurses ask you about what could have gone better over the last 12 hours?
Did the nurses ask you about what you would like to have happen during the next 12 hours?
Did the nurses ask you about your pain?
Lichert Scale
I was informed of my plan of care for the day
There was open communication between the nurses about my plan of care
I feel involved in my plan of care
My care providers worked together as a team
Comments about communication between nurses and patients

23. Did your nurses come into the room together at the last shift change?

24. Did the nurses ask you about what could have gone better over the last 12 hours?

25. Did the nurses ask you about what you would like to have happen during the next 12 hours?

26. Did the nurses ask you about your pain?

27. I was informed of my plan of care for the day

28. There was open communication between the nurses about my plan of care

29. I feel involved in my plan of care

30. My care providers worked together as a team

31. Patient Comments The nurses work together, the doctors seem separate
Please introduce yourself, need more communication about delays
I think the nurses are doing great, I want more frankness, I appreciate continuity of care
Every time they come in they explain things, feels reassuring
I think the communication is on the spot, you guys do a good job

32. Next Steps Finish pre-intervention patient interviews
Conduct unit education on scripted questions to increase patient involvement in the bedside handoff conversation
Allow time for change to be implemented into practice
Collect post-intervention data

33. References
Tobiano, G., Chaboyer, W., McMurray, A. (2012) Family members’ perceptions of the nursing bedside handover. Journal of Clinical Nursing 22,
CMS (2014) HCAHPS: Patients’ Perspectives of Care Survey. Available at
Joint Commission (2014): Hospital: 2014 National Patient Safety Goals. Available at