“Nurses are much more focused during handoff at the bedside than they had been under the old method.”
- Charleen Tachibana, RN
How would you like to implement something in your hospital right away that would dramatically improve the safety of your patients, as well as the overall patient experience?
At Virginia Mason, this was accomplished by doing handoffs at the patient’s bedside.
The difference between the old way of handing off and the bedside approach is night and day. Under the old approach, nurses gathered in a conference room tucked away from patients. Behind closed doors, incoming and outgoing nurses would exchange information on patients.
“And it was after that when nurses would do their check-ins with their patients, so it meant that nurses had met and talked with their patients 90 minutes after the shift started,” says Charleen Tachibana, RN, Virginia Mason Hospital Administrator and Chief Nursing Officer. “Now, with bedside handoff, the nurses are in all their patients’ rooms in the first 30 minutes of the shift.”
At this point, it should be noted that while it may sound simple, implementing bedside handoffs didn’t happen overnight at Virginia Mason. This kind of transition is a process and depends on organizational culture, foundational elements and other factors.
Under the new approach, the incoming and outgoing nurses are together at the patient’s bedside discussing their care, usually with the patient included in the conversation and often with family members joining in.
“Nurses are much more focused during handoff at the bedside than they had been under the old method,” says Charleen. “When they were sitting back in the conference room, there was a social component mixed in and they might be distracted and were not as focused. The quality of the exchange at the bedside is just so much better than when it happens in the conference room over coffee.”
When nurses do the handoff together there is a synergy to the work. One nurse will point out certain things about a patient to the oncoming nurse, who might then notice something else important or who will then ask a question he/she might not have otherwise thought to ask.
For example, in the case of patients with neurological issues, think about the difference in the quality of a handoff when it happens at bedside as opposed to away from the patient in a conference room.
“At the bedside the nurses do a neuro check to make sure they are both seeing the same thing,” says Charleen. “This way, they establish a baseline together so if there are subtle changes to come the nurse will see them. Think of how much better this kind of care is than when a nurse in a closed conference room explains neuro symptoms. Seeing those symptoms first hand – it is just a huge difference.”
At the bedside, nurses also do a high-risk medication check – double-checking the highest risk medications. “Together, they check the medication, its concentration, the rate of flow,” says Charleen. “They visualize it – seeing the machine and the rate it is running.”
A significant benefit of the bedside handoff is the inclusion of patients.
“There was an instance where a significant error was caught by a patient,” says Charleen. “It related to an allergy and if the handoff had been back in the conference room the error would not have been caught. The fact that the patient was involved meant that inaccurate information was corrected and not passed along to the next shift.”
Just as patients play a critical role in the handoff process, so too do patients’ families – a great source of information and support for the care team.
“Family members are so much more comfortable and relaxed when they see the handoff take place and they know that critical information has been passed along from one nurse to the next,” says Charleen. “That was really a significant development – family engagement and satisfaction – that we really had not anticipated when we made the shift to the bedside.”
There was one particular family member who carefully watched over the care for her husband and she would remain in his room during the nurse handoff from the evening to the night shift. “She told us that when she saw the handoff and knew that all the important, accurate information had been passed along, she felt comfortable enough to go home and get a night’s sleep,” Charleen says.
The whole idea of moving the handoff to the bedside was originally driven by an effort to improve efficiency and eliminate various wastes – such as time and manpower. But an enormously important byproduct of the change has been making patient care safer.
“It took us by surprise,” says Charleen. “We didn’t think we’d be catching so many things during the bedside transfer of information.”
Virginia Mason now has five years experience with the bedside handoff. While there was a bit of resistance at the beginning (“Patients don’t really want us to do it in their presence …” “It will take too long …”), there is no question it is one of the more effective changes the organization has made. When one change yields such rich rewards – in safety, quality, and patient and family satisfaction – it is clearly the kind of approach that could spread nationally.
What seemingly simple changes have you made to improve patient care or customer service in your organization?
Come Chat with Us
Mark your calendar for noon PDT (3 p.m. EDT) Thursday, Sept. 5, for a Twitter chat with Chris Backous of the Virginia Mason Institute. He’ll be discussing Virginia Mason’s lean transformation and the Virginia Mason Production System, and answering questions to help in you in your organization’s improvement journey. Join the conversation at #ASKVM.