Dealing Effectively with Shift Changes and Patient Handoffs

If you have kids, you know the worst time of day is that hour before dinner – kids are needy and cranky after school, homework has to get started, and dinner has to be created. Similarly, if you are a nurse, you know the worst part of your day is shift change.

If you have kids, you know the worst time of day is that hour before dinner – kids are needy and cranky after school, homework has to get started, and dinner has to be created. Similarly, if you are a nurse, you know the worst part of your day is shift change. Patients are cranky and needy, meds need to be passed, and you are desperately trying to either give or get reports on the highlights of each of your patients’ emotional, mental and physical needs. But the stakes at the hospital are higher than hungry, cranky kids.

Ineffective handoffs can be deadly. In one handoff study, Dr. Michael Cohen of the University of Michigan, studied the handoffs of 262 patients at a hospital in Ontario, Canada. The sampling describes a common practice among nurses and physicians – health care providers start from the beginning of the bed list and work their way down the line. Reports were not given in order of the acuity of the patients. The problem? Staff spent more time on patients at the beginning of the list than those at the end of the list, regardless of how ill the patients were at the end of the list. It’s tough at the end of a shift – the outgoing staff is exhausted, and it can be tricky to get the allotted time free from patient care. Most health care providers can recount being pulled out of report because of emergencies.

There is movement toward having change of shift reporting with nurses happen at the bedside. Some major advantages are that patients and family members can hear the report and ask questions. This practice also present positively impacts the time spent with people who find themselves at the end of that patient list.

Disadvantages can be that patients and family members start asking lots of questions, and it becomes more time-intensive than you can manage. Also, some specialties, like psychiatric care, are not suited for bedside reports.

As more and more hospitals shift toward electronic medical records (EMR), hospitals will find ways to utilize them to a greater degree in reporting. Already some EMR systems include checklists for patient handoffs which include offering patients and their family an opportunity to ask questions.

Patient handoffs at the end of a shift, when you just want to get home and take a bath or go straight to bed, can sometimes feel like an extra burden, but don’t let that impact this essential part of providing good patient care. Your bath and bed will still be waiting for you, and will be even more relaxing if enjoyed along with the peace of mind that comes with providing excellent patient care.