A bedside reporting system piloted in the Wilmington Hospital Emergency Department aims to improve patient hand-offs throughout the hospital. Nurses in the Wilmington Hospital ED have been using the system, called CHAT, for almost one year now, rolling it out slowly so everyone has had a chance to get used to the change in shift reports.
CHAT stands for: C—Communicate and Clear; H—History; A—Assessment and Actions; T—Treatment Plan.
The two nurses who spearheaded the initiative in the Wilmington Emergency Department are Isabel Pearce, RN, and Nicole McCarry, RN. In addition to conducting the training and working to alleviate their colleagues’ concerns about the process, Pearce and McCarry also conducted a six-month study to look at how bedside reporting would impact both patient and nurse satisfaction.
“The results in terms of patient satisfaction were almost immediate. Scores have reached the highest level in the department’s history, mirroring experiences of other ED bedside report models across the country,” Pearce says. “The data supports the theory that bedside reporting increases patient satisfaction and positive patient outcomes. Even length of stay can be decreased, because the oncoming nurse is told of impending lab and imaging results, which when available allow the nurse to partner with the physician for a timely disposition.”
For McCarry, it has always been part of her nursing style to include patients in their own care. Formalizing a system of reporting between shifts just made sense to her.
“The most obvious benefit is patient satisfaction,” McCarry says. “Patients are very happy with feeling that they are not being abandoned when one nurse ends a shift and another comes on. The patients are more aware, and they develop a genuine respect for the nurses and staff.
“From the nurse’s perspective, it doesn’t leave you questioning what may or may not have been done. If there is an acute change, you recognize it quickly. For example, you have been told a patient was talkative, and now the patient is slow to even respond. If both nurses are standing there, you can ask, ‘Is this how they were earlier?’ It’s a good, visual, hands-on approach to hand-offs. And it’s better for care.”
At Wilmington Hospital, nurses in the Emergency Department are using CHAT approximately 85–90 percent of the time, says Susan Angeline, RN, nurse manager of the Wilmington Emergency Department. The goal is to reach 100 percent compliance in the next year.
The nurses who coordinated the CHAT roll-out admit that it can be difficult to accommodate such a big change in the way reporting has always been done—generally at the nursing desk where patients can’t hear any of the nursing report. Some nurses were concerned about conducting bedside report in special patient populations where patients might be intoxicated, combative or have an acute mental status change.
“Although bedside reporting can be uncomfortable, in most cases it’s actually safer for nurses and patients for the oncoming nurse to get that accurate assessment at the beginning of his or her shift,” Pearce says. “Many of those ‘uncomfortable’ patients are at the highest risk for falls and change in condition. Bedside reporting and the additional care it brings can help protect the patient, but also helps protect the nurses and their licenses by accurate assessment at the nurse’s assumption of care.”
She adds that CHAT doesn’t require nurses to share all information at the patient’s bedside. If there are issues that need to be shared only between the two nurses, it’s appropriate to share that information outside of the patient’s room.
“Resistance to the change fades quickly once nurses begin to see the benefits of CHAT,” McCarry says. “It really is better for the patients and for the nurses. Everyone will eventually see this is the direction we are going in, and it is a positive thing.”