The importance of how well nurses communicate with each other,

physicians, nursing assistants, pharmacy staff, and janitorial staff makes the

difference in patient care and safety and the patient’s attitude toward

healthcare and compliance with their plan of care

Baggs et al. (1992) have observed improved communication and

collaboration results in more positive patient outcomes, higher satisfaction,

and lower readmission rates. If nurses are at the heart of the communication

process, and are carrying out this process efficiently, then it’s safe to say that

the client is more likely to have increased positive patient outcomes and

higher satisfaction with the care being provided.

Evidence suggests that communication improves when nursing handoff

involves the patient and is carried out using a structured reporting format

(Mascioli et al 2009, Tucker et al 2009).

The World Health Organization (2007) recommends the use of the SBAR

(Situation, Background, Assessment, and Recommendation) tool to

standardize handoff communications. The hospital where our research was

conducted has a policy in place that states using the SBAR tool when giving

hand off information combined with bedside report.

Bedside Reporting, which is what our study facility participates in, is only

effective when done properly and even then has its drawbacks. A simple

drawback is the “inclusion-exclusion” of patient’s from their care. The RN’s

may be in the patient’s room, but the focus is on discussing the case to the

next RN on duty in terminology that the patient does not understand. This

creates a “parallel” perception of RN care from the patient, which is better

than no perception, but can still be improved upon for better patient

outcomes.

Hannah Chitkara; Kiristan Dials; Kati Schuh; Nick Thompson; Celena Wagner; Mrs. White, MSN, RN

NURB 361 Introduction to Nursing Research, Baccalaureate Nursing Program

Introduction Literature Review

A PROTOCOL TO ENHANCE NURSE-TO-NURSE

COMMUNICATION DURING PATIENT HANDOFF

Policy Alterations

The objective of this project is to observe, analyze, and

ascertain nurse to nurse communication methods within a

moderate sized, urban, teaching hospital within Kentucky

and propose recommendations to increase the effectiveness of

nurse to nurse hand-off and nurse telecommunications for

better patient outcomes. Improved communication techniques

will ultimately lead to higher quality, holistic nursing care

and therefore increase rates of patient safety and satisfaction.

This will be completed by conducting nurse discussions,

observing nurse implementation, and analyzing hospital

policy to uncover barriers to efficient communication. Further

research and analysis upon the hospital’s current policy

revealed obstacles to efficient patient handoff. Discussion

with nurses on the unit revealed negativity regarding the

current practice of bedside reporting. Observation of 13

weeks within the hospital revealed variance from the policy

by staff members. Delving into current evidence based

practice techniques, a modification was proposed. Nurse shift

reports and nurse handovers are two of the most critical

processes in patient care that can support patient safety and

reduce medical errors in the United States (Gregory, 2014). A

timely, efficient patient handoff is of vital importance to the

beginning of a shift adhering to patient-care, and the focus of

this project was conducted upon this premise.

Clinical Implications

Adherence to the hospital’s handoff

communication policy regarding the use of

Situation Background Assessment

Recommendation (SBAR) when passing on

specific relevant information from one team

member to another for the purpose of ensuring

the continuity and safety of the patient.

Proposed model creates a more meaningful, time

saving method of patient handoff therefore

increasing both nurse and patient participation.

Patient Satisfaction Survey results will improve

thereby increasing hospital reimbursement.

More meaningful time spent with patient- rather

than discussing case in parallel to patient

speaking in medical jargon, Nurse would be

speaking directly to them in understandable

terms.

Less HIPAA violations.

Having an effective patient handoff would lead

to more holistic nursing care, leading to less

morbidity and mortality.

Patient Satisfaction Survey

Proposed Patient Hand-Off

Modification

IncreasedHand-Off

Report Efficiency

LessMorbidity and

Mortality

Less HIPAA Violations

Higher Patient Satisfaction

More Hospital Reimbursement

80%

52%

72%75%

49%

65%

NURSES "ALWAYS"

COMMUNICATED

WELL

PATIENT'S WHO

"STRONGLY AGREE"

THAT THEY

UNDERSTOOD CARE

WHEN LEAVING

HOSPITAL

PATIENT'S WHO GAVE

THEIR HOSPITAL A

RATING OF 9 OR 10

National Average Urban Teaching Hospital

Current Policy

30 minute

complete bedside report

SBAR

Proposed Modification

15 minute RN to RN patient handoff in designated area

15 minute patient rounding

Patient

Centered

CareIncreased

Nurse

Participation

Positive

Patient

Satisfaction

Surveys

References

Agency for Healthcare Research and Quality (2013). Nurse bedside shift report and implementation handbook. Retrieved

from http://www.ahrq.gov/profressionals/systems/hospital/engagingfamilies/stragegy3/index.html

Baggs, J., Ryan, S., Phelps, C., Richeson, J., & Johnson, J. (1992). The association between interdisciplinary collaboration and

patient outcomes in medical intensive care. Heart Lung, 21, 18–24

Casey, A., & Wallis, A. (2011). Effective communication: Principle of nursing practice E. Nursing standard, Vol. 25, pp. 35-37

Christie, P., & Robinson, H. (2009) Using a communication framework at handover to boost patient outcomes. Nursing Times.

105, 47, 13-15.

Holzmueller, C., Timmel, J., Kent, P., Schulick, R., & Pronovost, P. (2009). Implementing a team based daily goals sheet in a

non-ICU setting. Joint Commission Journal of Quality Patient Safety, 35, 384–388.

Mascioli S, Laskowski-Jones L, Urban S, & Moran S (2009) Improving handoff communication. Nursing 2009. 39, 2, 52-55.

World Health Organization (2007) Communication During Patient Hand-Overs. http://bit.ly/ecCnXg (Last accessed: March 22

2011.)

Benefits of Modification