An auditing process at Sydney/Sydney Eye Hospital revealed that patients are not as involved as they could be during the routine bedside handover processes that occur between nursing shifts.
A project was established to address this, and in doing so, improve the safety and satisfaction of the patient.
The original goal was that by October 2018, 80% of Ward 1 East nurses would engage with patients in the clinical handover huddle at the bedside.
While the project benefits are still emerging at the time of writing (April 2019), the benefits of this approach are well documented more broadly.
In particular, the concept of bedside clinical handovers leads to safer and higher quality care, which is integral to the provision of patient-centred care.
Specific patient benefits include:
- the ability to see and hear what the plan of care is, directly from the nurses
- the capacity to feel more comfortable to ask questions or voice concerns
- the reassurance that everyone is on the same page regarding their management
- the knowledge that they are more informed, leading potentially to less anxiety and more satisfaction
- the knowledge around who is looking after them; following a formal handover process which provides the opportunity for the patient to say goodbye and thank the nurse
- reduction of harm to patients, given the increased accountability that arises in a patient-centred handover process
- improved patient satisfaction which leads to less complaints.
Specific staff benefits include:
- the opportunity for real time conversations with patients
- nurses have more time to observe the patient
- improved safety of care exists, due to more structured communication with the patient
- a sense of team for nurses and the patient also exists, who feel they are part of an effective working team.
The concept of a ‘walk around bedside handover’ was originally introduced to enhance patient-centred care, where nurses speak to every patient as part of their handover process at the start and end of each shift. This is anecdotally referred to as the ‘bedside huddle’ or ‘handover huddle’.
This approach reflects the standard of clinical handover where patient involvement is highly valued, as required by the Australian Commission on Safety and Quality in Healthcare (Standard 6 Communicating for Safety).1
While a bedside clinical handover process was in place at Sydney/Sydney Eye Hospital, observational audits reveal that despite nurses conducting part of the handover at the bedside, the patient was rarely engaged in the discussion.
These audits also showed:
- on average 50% of nurses introduced themselves to the patients
- surveys from 2016 with patients (while still an in-patient) identified that they would like all nurses to introduce themselves when they take over care
- an overwhelming 87% of patients felt that they would like to be asked about their needs and concerns, and to have the opportunity to share any questions they might have about care while the handover was taking place
- all patients wanted their ongoing treatment plan briefly discussed with them at handover, but only 75% wanted to actually be included in the handover conversation as part of the team.
These insights led to the opportunity to improve safety and patient-centred care within Ward 1 East at Sydney/Sydney Eye Hospital, which houses 29 inpatient beds for complex surgical and medical ophthalmology conditions.
Following an analysis of the audit insights, focus groups in the Ward 1 East nursing staff identified these ideas for implementation.
- Interruptions during handover were cited as a key reason behind why the handovers did not include the patient as much as they could have. To address this, initiatives such as visual ‘do not disturb signs’ were placed on the ‘workstations on wheels’ during handovers. The role of a clerk was also proposed, to take messages for non-urgent phone calls during handover.
- A central handover was deemed necessary; with all nursing staff and the nurse in-charge or nursing unit manager involved. This was suggested to take place before staff disperse to their patients for the bedside handover. This central handover covers general information, safety alerts and anything highly confidential regarding a patient. The central handover helps to reduce time spent by the patient’s bedside on issues which could be covered in this central meeting; which frees up more quality time with the patient at the bedside instead.
Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.
South Eastern Sydney Local Health District -Sydney Hospital and Sydney Eye Hospital - Ward 1 East
Clinical Excellence Commission. Clinical Leadership Program
Bedside handover huddles will be evaluated once again by patient feedback, staff surveys and observational audits of compliance; as well as measuring the number of interruptions during handover. Outcomes will be updated in due course.
Since embarking on this project, new literature has been published regarding the evaluation of bedside handovers and this new research will be considered in future work on this topic.2-3
- The importance of local leadership, such as through the role of the nurse unit manager to shape the success of this project
- The importance of starting early on any project within the clinical leadership program calendar
- The value of discipline and focus, with particular reference to the use of a schedule to keep the project on track
- The understanding that challenges will arise, which can include staff on leave, changing roles and competing priorities. These challenges help to teach the resilience required to continue the project
- The need to seek advice that helps to plan how data will be measured, before starting the project.
- The Australian Commission on Quality and Safety in Health Care. National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACQSHC; 2017.
- Forde M, Coffey A, Hegarty J. The factors to be considered when evaluating bedside handover. J Nurs Manage, 2017. 1-12. doi:10.1111/jonm.12598
- Redley B, Waugh R. Mixed methods evaluation of a quality improvement and audit tool for nurse to nurse bedside clinical handover in ward settings. Applied Nursing Research. 2018:40;80-89.
- Baker S. Bedside shift report improves patient safety and nurse accountability. International Journal of Nursing Studies. 2010:36(4);355-257.
- Kerr D, Lu S, McKinlay L. Towards patient centred care: perspectives of nurses and midwives regarding shift to shift handover. International Journal of Nursing Practice. 2014:20; 250-257.
- McMurray A, Chaboyer W, Walli M, et al. Patient perspectives of bedside nursing handover. Collegian. 2011:18;19-26.
Sydney/Sydney Eye Hospital
South Eastern Sydney Local Health District
Phone: 02 93827542