Feasibility, Appropriateness, Meaningfulness and Effectiveness of Bedside Shift Reporting

Patient Participation at the Bedside: Feasibility, Appropriateness, Meaningfulness and Effectiveness of Bedside Shift Reporting. A Matched Controlled Trial

Hospitals face the challenge to continually improve their quality of care. In order to achieve this goal, they have to focus on both improving clinical practice and increasing the involvement of patients in the healthcare process. Both factors are equally important to quality of care. The World Health Organization highlights the role that patients and their family could play in the improvement of healthcare. Active patient participation reduces communication errors, increases patient empowerment and is associated with positive health and psychosocial outcomes. A possible strategy to improve patient participation through communication can be bedside shift report (BSR).

Bedside shift report is a process where shift-to-shift report between nurses is, if approved by the patient, executed at the patient's bedside in order to improve the patient's involvement. Bedside shift report has the potential to result in more patient satisfaction, better clinical outcomes, improvement of health education and enhanced team coherence. Preliminary research indicates that BSR decreases safety incidents and adverse events and readmissions, positively influences staff satisfaction, offers beneficial financial effects by reducing nurses' overtime, and allows direct patient care to start earlier.

Despite of these effects, rigorous and large-scale scientific research on this topic is lacking. Currently, the available evidence is scarce and mostly consists of single case or small-scale studies. Longitudinal results on effectiveness and sustainability of BSR are also unknown or inconclusive. There is a need for an increased number of controlled studies to evaluate the impact of BSR on patient, staff and economic outcomes and its longitudinal results.

The aim of this study is four-folded:

1. The development and fine-tuning of a BSR-intervention and implementation protocol by using diagnostic interviews, co-design, and pilot studies.
2. A quantitative evaluation of BSR in comparison with care as usual on patient-related, clinical, and nurse-related outcomes.
3. A qualitative evaluation of the feasibility, appropriateness and meaningfulness of BSR as a method to improve communication and patient participation with a particular interest in the experience of benefits and disadvantages by healthcare professionals and patients.
4. A process evaluation of BSR to determine the intervention fidelity and to assess the evolution of BSR over the period of the study (e.g. adaptations, consistent practice).

The study design was based on the Medical Research Council-framework for developing and evaluating complex interventions. Power calculation indicates a minimum of 5 experimental wards with 35 patients should be included in the study. The hospital, the specialization of the ward and the nurse-patient ratio will be used for the matched controlled assignment.

Study Overview

• Status: Completed
• Conditions: Patient Participation; Nursing; Bedside Shift Report
• Intervention / Treatment: Behavioral: Bedside shift report

• Study Type: Interventional
• Enrollment (Actual): 750
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Belgium
  • Brugge, Belgium, 8000
    • AZ Sint-Jan
  • Eeklo, Belgium, 9900
    • AZ Alma
  • Ghent, Belgium, 9000
    • Ghent University Hospital
  • Ghent, Belgium, 9000
    • AZ Sint-Lucas
  • Hasselt, Belgium, 3500
    • AZ Virge Jessa
  • Kortrijk, Belgium, 8500
    • Az Groeninge
  • Lokeren, Belgium, 9160
    • AZ Lokeren
  • Oudenaarde, Belgium, 9700
    • AZ Oudenaarde

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Patients

Inclusion Criteria:

• Admitted on a participating hospital ward
• Be conscious
• Speak Dutch
• Participated in at least 3 bedside shift reports

Exclusion Criteria

• Dementia or other severe cognitive/mental disorders

Nurses

Inclusion Criteria:

• Work on a participating hospital ward
• Have at least six months of experience on the ward
• Have participated in 10 bedside shift reports or more

Exclusion Criteria:

• No hands-on patient contact
• Internship

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Bedside shift report; The experimental group (nurses and patients) will: develop a tailored BSR-intervention by use of co-design, diagnostic interviews, and pilot testing; use the tailored BSR-intervention, with participation of the patient, instead of the regular nurse shift report	Behavioral: Bedside shift report; Bedside shift report is a process where shift-to-shift report between nurses is, if approved by the patient, executed at the patient's bedside in order to improve the patient's involvement (Anderson & Mangino 2006).; Other Names: Bedside shift handover
No Intervention: No bedside shift report; The control group will not use bedside shift report, but will use the regular nurse shift report without participation of the patient

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Patient Empowerment	The change in Patient Empowerment during the study will be investigated by use of repeated measures. The patterns of change between baseline, 12 months, 18 months, and 24 months will be evaluated. The data will be collected by use of a questionnaire for patients. A validated tool, the Patient Activation Measure (PAM13), will be used.	24 months: 4 data collections during the study (baseline, 12 months, 18 months, 24 months)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Quality of Care	The change in Quality of Care during the study will be investigated by use of repeated measures. The patterns of change between baseline, 12 months, 18 months, and 24 months will be evaluated. The data will be collected by use of a questionnaire for patients. A validated tool, the QPP (Quality of care from the Patient's Perspective), will be used.	24 months: 4 data collections during the study (baseline, 12 months, 18 months, 24 months)
Change in Individualized Care (patient)	The change in Individualized Care during the study will be investigated by use of repeated measures. For patients, the patterns of change between baseline, 12 months, 18 months, and 24 months will be evaluated. The data will be collected by use of a questionnaire for patients. A validated tool, the ICS (Individualized Care Scale), will be used.	24 months: 4 data collections during the study (baseline, 12 months, 18 months, 24 months)
Change in Individualized Care (nurse)	The change in Individualized Care during the study will be investigated by use of repeated measures. For nurses, the patterns of change between baseline and 24 months will be evaluated. The data will be collected by use of a questionnaire for nurses. A validated tool, the ICS (Individualized Care Scale), will be used.	24 months: 2 data collections during the study (baseline, 24 months)
Change in Job Satisfaction	The change in Job Satisfaction during the study will be investigated by use of repeated measures. The patterns of change between baseline and 24 months will be evaluated. The data will be collected by use of a questionnaire for nurses. A validated tool, the MOAQ-JSS (Michigan Organizational Assessment Questionnaire - Job Satisfaction Subscale), will be used.	24 months: 2 data collections during the study (baseline, 24 months)
Change in Turnover Intention (1)	The change in Turnover Intention during the study will be investigated by use of repeated measures. The patterns of change between baseline and 24 months will be evaluated. The data will be collected by use of a questionnaire for nurses. A validated tool, the MOAQ-TIS (Michigan Organizational Assessment Questionnaire - Turnover Intention Subscale), will be used.	24 months: 2 data collections during the study (baseline, 24 months)
Change in Turnover Intention (2)	The change in Turnover Intention during the study will be investigated by use of repeated measures. The patterns of change between baseline and 24 months will be evaluated. The data will be collected by use of a questionnaire for nurses. Two questions from the RN4CAST (Nurse Forecasting: Human Resources Planning in Nursing) are used.	24 months: 2 data collections during the study (baseline, 24 months)
Change in Coordination of the Care Process	The change in Coordination of the Care Process during the study will be investigated by use of repeated measures. The patterns of change between baseline and 24 months will be evaluated. The data will be collected by use of a questionnaire for nurses. A validated tool, the CPSET-COR (Care Process Self Evaluation Tool - Coordination subscale), will be used.	24 months: 2 data collections during the study (baseline, 24 months)
Change in Communication	The change in Communication during the study will be investigated by use of repeated measures. The patterns of change between baseline and 24 months will be evaluated. The data will be collected by use of a questionnaire for nurses. A validated tool, the CPSET-COM (Care Process Self Evaluation Tool - Communication subscale), will be used.	24 months: 2 data collections during the study (baseline, 24 months)
Change in Work Interruptions (1)	The change in Work Interruptions during the study will be investigated by use of repeated measures. The patterns of change between baseline and 24 months will be evaluated. The data will be collected by use of a questionnaire for nurses. A non-validated tool to measure nurses' perceptions on work interruptions, developed by the researchers, will be used.	24 months: 2 data collections during the study (baseline, 24 months)
Change in Work Interruptions (2)	The change in Work Interruptions during the study will be investigated by use of repeated measures. The patterns of change between baseline and 24 months will be evaluated.. The data will be collected from electronic databases from within the participating hospitals that measure the number of work interruptions ('calls for assistance').	24 months: 2 data collections during the study (baseline, 24 months)
Change in Patient Participation	The change in Patient Participation during the study will be investigated by use of repeated measures. The patterns of change between baseline and 24 months will be evaluated. The data will be collected by use of a questionnaire for nurses. Five questions from a validated tool, the PaCT-HCW (Patient Participation Culture Tool for Healthcare Workers), will be used.	24 months: 2 data collections during the study (baseline, 24 months)
Change in Hospital Acquired Pressure Ulcers (HAPU)	The change in incidence of HAPU's during the study will be investigated by use of repeated measures. The patterns of change between baseline, 12 months, 18 months, and 24 months will be evaluated. The data will be collected from the patient's medical file. The timeframe for registration is from the admission on the ward until discharge from the ward. Any HAPU's during the patient's stay on the ward on heel and sacrum will registered by use of the NPUAP/EPUAP classification system.	24 months: 4 data collections during the study (baseline, 12 months, 18 months, 24 months)
Change in Patient Falls	The change in incidence of Patient Falls during the study will be investigated by use of repeated measures. The patterns of change between baseline, 12 months, 18 months, and 24 months will be evaluated. The data will be collected from the patient's medical file. The timeframe for registration is admission on the ward until discharge from the ward. Any patient falls during the patient's stay on the ward will registered.	24 months: 4 data collections during the study (baseline, 12 months, 18 months, 24 months)
Change in Unnecessary New Intravenous Drips	The change in incidence of Unnecessary New Intravenous Drips during the study will be investigated by use of repeated measures. The patterns of change between baseline, 12 months, 18 months, and 24 months will be evaluated. The data will be collected from the patient's medical file. The timeframe for registration is from admission on the ward until discharge from the ward with a maximum of 30 days. Newly placed intravenous drips without explicit physician indication will be registered.	24 months: 4 data collections during the study (baseline, 12 months, 18 months, 24 months)
Change in Length of Stay	The change in Length of Stay during the study will be investigated by use of repeated measures. The patterns of change between baseline, 12 months, 18 months, and 24 months will be evaluated. The data will be collected from the patient's medical file. The total length of stay on the ward will be registered.	24 months: 4 data collections during the study (baseline, 12 months, 18 months, 24 months)
Change in Unplanned Readmission	The change in incidence of Unplanned Readmissions during the study will be investigated by use of repeated measures. The patterns of change between baseline, 12 months, 18 months, and 24 months will be evaluated. The data will be collected from the patient's medical file. Readmissions within 30 days in the same hospital will be registered.	24 months: 4 data collections during the study (baseline, 12 months, 18 months, 24 months)
Change in Pain	The change in Pain scores during the study will be investigated by use of repeated measures. The patterns of change between baseline, 12 months, 18 months, 24 months will be evaluated. The data will be collected from the patient's medical file. The timeframe for registration is from admission on the ward until discharge from the ward. The first pain score after the nurse shift report will be registered each day.	24 months: 4 data collections during the study (baseline, 12 months, 18 months, 24 months)
Change in Duration of the shift report	The change in the Duration of the Shift Report during the study will be investigated by use of repeated measures. The patterns of change between baseline, 12 months,18 months, and 24 months will be evaluated. Thirteen shift reports will be recorded during each data collection point. Based on the recordings, the duration of the shift report will be calculated.	24 months: 4 data collections during the study (baseline, 12 months, 18 months, 24 months)
Feasibility	The data concerning the experienced Feasibility of BSR will be collected by use of individual, semi-structured interviews (patients) and semi-structured focus group interviews (nurses) using an interview guide. The data will be collected at 12 months.	12 months: 1 data collection (12 months)
Applicability	The data concerning the experienced Applicability of BSR will be collected by use of individual, semi-structured interviews (patients) and semi-structured focus group interviews (nurses) using an interview guide. The data will be collected at 12 months.	12 months: 1 data collection (12 months)
Meaningfulness	The data concerning the experienced Meaningfulness of BSR will be collected by use of individual, semi-structured interviews (patients) and semi-structured focus group interviews (nurses) using an interview guide. The data will be collected at 12 months.	12 months: 1 data collection (12 months)
Change in Intervention Fidelity	The change in Intervention Fidelity during the study will be investigated by use of repeated measures. The patterns of change will be evaluated. The data will be collected by use of non-participating observations. A checklist will be used. During each period (12 months until 18 months / 18 months until 24 months) 20 non-participating observations on each ward will be performed.	24 months: 2 data collections during the study(between 12 months and 18 months; between 18 months and 24 months)

Collaborators and Investigators

• Sponsor: University Hospital, Ghent
• Collaborators: University Ghent
• Investigators: Principal Investigator: Ann Van Hecke, MSc, PhD, Ghent University/Ghent University Hospital; Principal Investigator: Kristof Eeckloo, LMM, PhD, Ghent University/Ghent University Hospital; Principal Investigator: Wim Van Biesen, MD, PhD, Ghent University/Ghent University Hospital

Publications and helpful links

General Publications

• Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001. Available from http://www.ncbi.nlm.nih.gov/books/NBK222274/
• Smeulers M, Lucas C, Vermeulen H. Effectiveness of different nursing handover styles for ensuring continuity of information in hospitalised patients. Cochrane Database Syst Rev. 2014 Jun 24;2014(6):CD009979. doi: 10.1002/14651858.CD009979.pub2.
• Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud. 2013 May;50(5):587-92. doi: 10.1016/j.ijnurstu.2012.09.010. Epub 2012 Nov 15. No abstract available.
• Anderson CD, Mangino RR. Nurse shift report: who says you can't talk in front of the patient? Nurs Adm Q. 2006 Apr-Jun;30(2):112-22. doi: 10.1097/00006216-200604000-00008.
• Cairns LL, Dudjak LA, Hoffmann RL, Lorenz HL. Utilizing bedside shift report to improve the effectiveness of shift handoff. J Nurs Adm. 2013 Mar;43(3):160-5. doi: 10.1097/NNA.0b013e318283dc02.
• Evans D, Grunawalt J, McClish D, Wood W, Friese CR. Bedside shift-to-shift nursing report: implementation and outcomes. Medsurg Nurs. 2012 Sep-Oct;21(5):281-4, 292.
• Gonzalo JD, Wolpaw DR, Lehman E, Chuang CH. Patient-centered interprofessional collaborative care: factors associated with bedside interprofessional rounds. J Gen Intern Med. 2014 Jul;29(7):1040-7. doi: 10.1007/s11606-014-2817-x. Epub 2014 Mar 11.
• Gregory S, Tan D, Tilrico M, Edwardson N, Gamm L. Bedside shift reports: what does the evidence say? J Nurs Adm. 2014 Oct;44(10):541-5. doi: 10.1097/NNA.0000000000000115.
• Griffin SJ, Kinmonth AL, Veltman MW, Gillard S, Grant J, Stewart M. Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials. Ann Fam Med. 2004 Nov-Dec;2(6):595-608. doi: 10.1370/afm.142.
• Longtin Y, Sax H, Leape LL, Sheridan SE, Donaldson L, Pittet D. Patient participation: current knowledge and applicability to patient safety. Mayo Clin Proc. 2010 Jan;85(1):53-62. doi: 10.4065/mcp.2009.0248.
• Wakefield DS, Ragan R, Brandt J, Tregnago M. Making the transition to nursing bedside shift reports. Jt Comm J Qual Patient Saf. 2012 Jun;38(6):243-53. doi: 10.1016/s1553-7250(12)38031-8.
• Malfait S, Eeckloo K, Van Opdorp L, Van Biesen W, Van Hecke A. The impact of bedside handovers on relevant clinical indicators: A matched-controlled multicentre longitudinal study. J Adv Nurs. 2020 Apr 29. doi: 10.1111/jan.14406. Online ahead of print.

Study record dates

Study Major Dates

• Study Start: March 1, 2016
• Primary Completion (Actual): April 1, 2018
• Study Completion (Actual): May 1, 2018

Study Registration Dates

• First Submitted: February 29, 2016
• First Submitted That Met QC Criteria: March 15, 2016
• First Posted (Estimate): March 21, 2016

Study Record Updates

• Last Update Posted (Actual): June 16, 2021
• Last Update Submitted That Met QC Criteria: June 15, 2021
• Last Verified: June 1, 2021

More Information

Terms related to this study

• Keywords: Nursing; Bedside; Patient participation; Mixed method; Shift report; Matched controlled trial
• Other Study ID Numbers: HA/RP/2015/086/EC; B670201627044 (Other Identifier: Ethics Committee UZ Gent)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No