Listening to voice of the patient in developing a Patient Centered Handoff

Purpose:
A new patient centered handoff process was developed that provides patients and their families the opportunity to participate in the change of shift handoff process. A study was undertaken to assess patient perceptions of the new handoff process in order to improve communication in the handoff.

Background/Significance:
Handoffs are one of the most complex communication processes in providing patient care. Inadequate or unclear handoffs place patients at risk for safety breaches that disrupt continuity of care and increase the risk of adverse outcomes. Analysis of handoff policies in a multi-hospital system indicated variance in definitions and processes across the system and opportunities for improvement. The system responded by developing a new patient-centered strategy to improve the handoff process.

Methods:
A descriptive study was conducted to assess patient perceptions regarding the new handoff process: ISHAPED (I=Introduce, S=Story, H=History, A=Assessment, P=Plan, E=Error Prevention, and D=Dialogue). The convenience sample consisted of 107 patients or parents of patients who met the eligibility criteria. The survey instrument included eleven Likert scale items, and three demographic questions. Statistical analysis was conducted A subset of 22 were interviewed. The data was imported into NVivo 9. Each sentence of the text was coded using an inductive approach. Codes were rechecked to assess their coding consistency. Qualitative content analysis was conducted.

Results:
Agreement by patients/parents regarding the ISHAPED process ranged from 3.6 to 4.6, (Likert Scale 1-strongly disagree to 5 strongly agree). The qualitative results obtained from 22 interviews provided insight into patient perceptions of the change of shift bedside report and identified handoff processes viewed favorably by patients, as well as challenges with the handoff process. Themes emerged from the content analysis. The results indicated patients valued the introduction of new nurses at the beginning of the shift and interactive communication which supported continuity of care. Additional opportunities to further engage patients in the bedside change of shift report were identified.

Conclusions and Implications for Practice:
Overall most patients in this sample viewed the bedside report favorably. Opportunities to improve the bedside report related to interactive communication process were identified. The implications highlight the importance of engaging patients to design processes to support patient-centered care.