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Bedside Report

Is it the best practice for our patients?

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Report is the transfer of responsibility, accountability and authority for a patient and their care from one nurse to another. Bedside report is the concept of giving report to the incoming nurse in the patient's presence; bedside report should include an opportunity for the patient to ask questions and receive clarification regarding his or her care.

Report is a traditional nursing practice that occurs throughout the world and across various specialties. However, research about report practices was not conducted until the 1990's and focused primarily on the differences in giving report via an audio recording and giving report face to face.1

The National Patient Safety Goals, issued by The Joint Commission in 2006, changed the focus of research on report to the benefits, risks and challenges of implementing bedside report. The Goals recommended healthcare organizations implement a standardized approach to 'hand off' communications that includes an opportunity to engage in discussion and ask questions.2

Benefits
Research on bedside report has found that moving report from the nurse's station to the patient room offers several benefits, including: increased nurse-to-nurse accountability, patient satisfaction scores, quality of care ratings and patient safety scores.

For example, a study conducted by two registered nurses at a rehabilitation center found that prior to implementing bedside report on their unit, 28% of the unit's registered nurses stated that they believed giving report at the bedside improved patient safety.3

Following the implementation of bedside report, 70% of the registered nurses stated that they felt bedside report improved patient safety. The same study also found that the nurses felt bedside report allowed them to better prioritize their day and plan for their shift.3
A report published by Terry Griffin (2010) found that bedside report led to a decrease in medication errors and accidents by providing an opportunity for the incoming nurse to visualize the patient and equipment in the patient's room.4

Maxson et al. (2012) found that following the implementation of bedside report, nurses felt better prepared to communicate with the physicians regarding their patient's care. The nurses in this study also noted their patient's increased satisfaction; in fact, one nurse stated that the report process was faster because "patients used their call lights less during shift change."5

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Challenges
Despite the well-documented benefits to bedside report, there are several concerns that exist when including the patient in the report.
One primary challenge is the potential violation of patient's privacy and confidentiality. One hospital successfully conquered this challenge when they transitioned to bedside report by doing two things.

First, the nurses discussed any sensitive information that they did not want the patient to be present for prior to entering the patient's room; second, before beginning report the nurses asked any guests present to step out of the room while they gave report.

One study conducted by Grant, B., and Colello, S. (2009) found that while some patients invited their guests to be present for report, others appreciated the respect for their privacy.6

There are still some hospitals that have multi-bed units or semi-private rooms, which can create significant challenges for bedside report. In these cases, privacy has to be addressed differently because there is a larger possibility of information being overheard during report.

One way to address this issue is to inform patients that such disclosures may occur and acquire a consent form. This would give staff an opportunity to introduce patients to the process, stress the importance of bedside report and offer patients an opportunity to ask questions regarding report.4

It was found that many nurses felt that implementing bedside report would significantly increase the amount of time it took to give report and result in decreased efficiency. However, a study conducted in an Australian hospital found that bedside report increased efficiency in two ways.1

First, by introducing patients to the oncoming nurse at the beginning of the shift and allowing them an opportunity to ask questions, bedside report minimized the number of times patients made requests for information or clarification throughout the shift.
Second, because bedside report requires both the oncoming and leaving nurse to be present in the room, it helps more experienced nurses act as role models to less experienced nurses. It also creates an opportunity for nurses to collaborate and accomplish tasks that would be more difficult to perform alone.1

Griffin (2010) found that implementing a standardized bedside report template increases efficiency and decreases the length of time spent giving report by eliminating discussion of extraneous or unnecessary information.4

Further Research
Despite current research that points to bedside report as the best practice standard, more research should be conducted regarding bedside report in all healthcare settings.

Although several studies exist regarding implementation of bedside report in medical-surgical and rehabilitation units and other similar settings, there are few studies on bedside report in settings such as labor and delivery, the emergency department and critical or intensive care units.

There is also insufficient research regarding the contents of report when given at the bedside. Much of the research agrees that bedside report should include a safety scan of the patient and environment, but none of the studies detail what information regarding patient care should be reported and what items should be observed for or checked during a safety scan.

Further research is necessary in order to continue to provide evidence on how vital bedside report and proper communication is to the health and safety of our patients.

Putting it Together
Bedside report is a valuable intervention to include in holistic care, and it can improve patient safety, increase patient satisfaction scores and increase quality of care.

Although healthcare professionals had initial concerns that bedside report would violate patient privacy and confidentiality, distract from patient care and create inefficiencies, research has shown that certain interventions can eliminate these problems.

Knowledge is power, and knowing the benefits and importance of bedside report can lead to change. With more studies to provide further evidence based research, bedside report can be an important tool to help boost patient outcomes.

Amanda Alexander, Michelle Fletcher, Rocio Navarro, Zoua Vang, and Kaitlyn Wakefield are students at California State University, San Bernardino. Their anticipated graduation date is June 2013.

Asma A. Taha, RN, PhD, CPNP-PC/AC, CCRN, nursing professor, California State University, San Bernardino contributed to this article.

References

1. Chaboyer, W., McMurray, A., & Wallis, M. (2010). Bedside nursing handover: A case study. International Journal Of Nursing Practice, 16(1), 27-34. doi:10.1111/j.1440-172X.2009.01809.x

2. Catalano, K. (2009). Legal department. Hand-off communication does affect patient safety. Plastic Surgical Nursing, 29(4), 266-270. doi:10.1097/PSN.0b013e3181c20136

3. Laws, D., & Amato, S. (2010). Incorporating bedside reporting into change-of-shift report. Rehabilitation Nursing, 35(2), 70-74.

4. Griffin, T. (2010). Bringing change-of-shift report to the bedside: a patient- and family-centered approach. Journal Of Perinatal & Neonatal Nursing, 24(4), 348-355. doi:10.1097/JPN.0b013e3181f8a6c8

5. Maxson, P. M., Derby, K. M., Wrobleski, D. M., & Foss, D. M. (2012). Bedside nurse-to-nurse handoff promotes patient safety. MEDSURG Nursing, 21(3), 140-145.

6. Grant, B., & Colello, S. (2009). Patient safety. Engaging the patient in handoff communication at the bedside. Nursing, 39(10), 22.

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Bedside reporting is definitely the way to go. I don't know what kind of ICU does not have monitors at the bedside where RNs wouldn't be able to give bedside report. I've began working in ICUs since 1996 and have always given bedside report. The only times I haven't done bedside report is when floated to Med-Surg units and that is where I believe it is needed the most. If your hospital leadership cannot figure out how the staff RN is supposed to give bedside report and have the patient's properly monitored you should probably find another hospital.

Eric ,  RN, MSN/MHAMay 19, 2013
Bartlett, TN



It is a horrible mistake to leave monitors with no technician watching them, so we can do bedside reporting. I don't know what unit you work in, but in the Intensive Care Unit, our patient's are mechanically ventilated and on vasoactive drips, some are unstable and require constant monitoring, but if we're caught doing report anywhere other than the bedside, we could get written up. Now THAT is horrible.

Janie Owen,  RN,  HospitalMay 08, 2013
Elko, NV



I think it is a horrible mistake to NOT have bedside reporting. It is to everyone's advantage and promotes the best of care for patients. the line of communication becomes much more effective. I think it's a must! You also have to remember that it a learned skill just as everything else is and it takes practice. Initially it will take longer but that will improve with use.

Lynette  Furnald February 27, 2013
CARLSBAD , CA




     

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