Bedside Report and Hourly Rounding (BRHR) Improving Patient and Staff Satisfaction

Purpose:
To increase both patient and staff satisfaction while improving patient safety through the use of data. BRHR increases accountability, and improves communication while incorporating the patient into their plan of care, enabling them to feel included in the decision-making process.

Significance:
Transforming Care at the Bedside (TCAB); an initiative led by the RWJ Foundation and the IHI; hopes to increase time nurses spend at the bedside. BRHR supports this initiative. By increasing nursing time with patients we hope to reduce our “never” events and standardize our communication process.

Strategy and Implementation:
Three medical-surgical units trialed uniquely different models of bedside report. After a 2 month period, staff met to discuss the pros and cons of each model trialed. The goal of the meeting was to individualize a process that we would then roll-out throughout the institution. The new reporting process was built by a PDSA, small cycle of change methodology. The strategy for the roll-out was to in-service one unit at a time, one shift at a time to perfect the process, identifying and correcting any barriers as they arose. New units were launched into the process only after previous units had full education and demonstrated success in all elements. A standardized Handoff Communication Tool to be utilized house-wide was developed and tested throughout the process incorporating all of the key areas to address our 2009 National Patient Safety Goals as well as our organizations commitment to significantly reduce CMS “ never events”.

Evaluation:
Staff and patients were surveyed on each unit. Staff preferred the new style of report by over 90% and 75% reporting increased peer accountability. Patient data showed 92% satisfaction with the initiative and 95% now feeling they are an integral part of the decision-making process.

Implications for Practice:
BRHR increases patient and staff satisfaction, professional accountability, while decreasing incidental overtime. Standardization ensures consistent communication, while improving patient safety and clinical care quality. By this process we hope to become both an employer and provider of choice.