Implementing Bedside Handoff in the Emergency Department: A Practice Improvement Project

Handoff in the emergency department is considered a high-risk period for medical errors to occur. In response to concerns about the effectiveness of the nursing handoff in the emergency department of a Midwestern trauma center, a practice improvement project was implemented. The process change required nursing handoff at shift changes to be conducted at the bedside, using an adapted situation, background, assessment, recommendation (SBAR) communication tool. For this project, the intervention effectiveness was measured using pre- and post-implementation scores on a nursing handoff questionnaire, selected items on the Hospital Survey on Patient Safety Culture, and handoff observations documented by nursing leadership. Questionnaire results revealed no change between pre- and post-implementation for 5 of the 7 questions. Responses to 2 questions showed improvement post-implementation. Scores from the Hospital Survey on Patient Safety Culture improved from 2015 to 2016. Observation data showed that some nurses needed prompting to perform the handoff at the bedside, and only 40% used the electronic medical record during handoff. Results showed that nurses found the SBAR bedside report method easy to use and prevented the loss of patient information more effectively than pre-intervention practice. Despite the strong evidence in the literature supporting bedside handoff, questions remain concerning its sustainability, as some nurses may resist such a change in the process of shift reporting.