Standardized Situation, Background, Assessment, Recommendations-Based Bedside Nursing Handoff

Abstract

Problem & Purpose: Annual nursing-communication patient satisfaction scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) at an academic hospital increased consistently for 3 years after hospital-wide nursing handoff improvements until a negative trend starting in 2021. Patient-reported handoff rate also dropped from consecutive 90%’s to 57% and 53% in 2020 and 2021, while the 14-bed Neurology Intermediate Care Unit (NIMC) dropped to 58% and 53% in 2020 and 2021. Methods: This quality improvement initiative implemented and monitored the effectiveness of a Situation, Background, Assessment, Recommendation (SBAR)-based tool with handoff and bedside discussion process for nursing shift reports in the NIMC. Handoff quality and nurse satisfaction were evaluated by 14-item Handover Evaluation Scale (HES) and patient satisfaction with HCAHPS reports. In-services and online education were completed by the 22 nurses to use SBAR-based handoff process at the bedside with suitable patients for 4 months with process adherence measured by observational and chart audits. Results: Nurse satisfaction and HES increased from 60% to 71% with a significant increase in 8 items. NIMC handoff rate increased from 53.1th to 58.7th despite a hospital-wide drop of 53rd to 51.7th percentile. There was an overall increase across AM and PM shift of process uptake and use of handoff tool. Conclusion: The SBAR-based handoff tool and process show positive effects on nurse satisfaction, quality of handoff, and retention of the tool, although a statistically significant increase was not found with HCAHPS-reported satisfaction. SBAR-based handoff is a cost-effective and sustainable way to improve nurse satisfaction and information quality with a standardized shift report and process.