Hospitals in pursuit of excellence

Bedside Change-of-Shift Reporting at Emory Healthcare

Emory Healthcare
Atlanta, GA

Emory Healthcare, a large academic teaching system, deployed a patient- and family-centered care transformation model in 2008.

The Problem
In partnership with patients and their families, Emory nursing staff created a set of evidence-based guidelines on items nurses should discuss during shift changes at the beside. Conducting change-of-shift reports at the bedside provides an opportunity for patients and families to become involved in the care team and participate in the sharing of information to ensure that patient, family and team priorities are identified.

The Solution
The goal of Emory’s bedside change-of-shift reporting is to engage patients and their families as partners in goal setting, treatment decisions and education. Patient and family advisors helped develop and test the protocols with nurses. Outcome analysis revealed that patient satisfaction improved so much in intensive care units that bedside shift reporting was implemented throughout all acute care areas at four of the Emory hospitals. Patient and family advisors served as instructors to train all front-line clinical staff on the new initiative. Nurses received ongoing training and feedback when necessary and helped train new units that adopted the policy.

The Result
Patient satisfaction increased. Press Ganey satisfaction scores for overall nursing care increased from the 41st percentile to 78th percentile, and patients’ ratings of how well nurses kept them informed increased from the 43rd to 80th percentile. While these increases cannot solely be attributed to the bedside change-of-shift reports, a 2011 survey of the Emory nursing staff showed that the measure of overall partnership was highest in units that used bedside shift reports. Quality outcomes also improved. Hospital-acquired pressure ulcers decreased from 8.15 percent to 2.5 percent, and patient falls decreased from 3.24 to 2.85 per 1,000 patient days.

Lessons Learned
Bedside change-of-shift reporting enhanced the engagement of staff with patients and families.

This case study was originally featured in the HPOE guide: "Engaging Health Care Users: A Framework for Healthy Individuals and Communities," published January, 2013.