IMPLEMENTING BEDSIDE SHIFT HANDOVER AND SHARED DECISION MAKING AT THE EMERGENCY DEPARTMENT; EFFECT ON PATIENT EXPERIENCES, NURSES’ JOB SATISFACTION AND RETENTION OF NURSES
In the Emergency Department (ED), time pressure, fluctuating levels of urgency and the dynamic nature of acute care make it challenging to consistently apply patient-centred communication and shared decision-making (SDM). Bedside shift handover (BSH) may support this by involving the patient directly in the handover process. This project examined how BSH & SDM can be introduced within a single ED, which conditions are required for successful implementation, and what effects occur on patient, nursing and process outcomes.
Objectives
The primary objective was to implement and evaluate the implementation of BSH&SDM in the ED. Secondary objectives were to measure effects on patient-centredness, patient satisfaction, ED length of stay, revisit rates, nurses’ job satisfaction and retention, and to identify organisational factors and competencies that facilitate or hinder the application of BSH&SDM.
Study design
We conducted a hybrid type III effectiveness–implementation study. Quantitative analyses covered 117,085 ED visits including BSH documentation, nursing workload (JDT), crowding (NEDOCS), length of stay, revisits and patient-reported experience measures (PPE/PEM). A CollaboRATE substudy was conducted among 104 patients. The qualitative component included patient interviews, focus groups with ED nurses and fly-on-the-wall observations of handovers. In addition, 62 nurses completed a survey on work engagement and perceived effects of BSH.
Objects of Study; All ED patients present during a scheduled nursing handover were included in the quantitative analyses, regardless of age, urgency or background. Additional inclusion criteria (alertness, language proficiency) applied to the interviews and CollaboRATE. All involved nurses and students could participate in the qualitative components and surveys.
Intervention
The intervention comprised: bedside handover using the SBAR structure; support for SDM through the 'Ask 3 Questions' tool; training and feedback sessions; the use of local champions; reminders; and integration of BSH into routine workflows.
Results
BSH use increased from 1.4% in the pre-implementation phase to 9.2% during implementation, with peaks up to 32% in months with intensive implementation activity. High workload reduced the likelihood of BSH; patient characteristics were not associated with use. Patients reported significantly better experiences: the proportion who felt involved in decisions rose from 19.6% to 75%. Overall satisfaction also increased. In the CollaboRATE substudy, involvement scores were moderate to high, though optimal scores were infrequent, indicating room for improvement in SDM quality. Revisit rates did not change. Slight increases in length of stay among BSH patients were attributable to higher complexity and diagnostic work-up.
Nurses reported that BSH improved patient contact, clarity and teamwork and did not add mental or physical strain. Focus groups and observations showed that SDM was mainly applied to small, feasible decisions and was influenced by clinical stability, time, language proficiency and privacy.
Discussion and Implications
This project demonstrates that BSH&SDM are feasible in the ED and that implementation is associated with improvements in patient involvement. Nursing workload remains the primary barrier to consistent use. SDM in the ED is inherently situational: patients expect rapid medical action in acute circumstances but value explanation, overview and involvement whenever the clinical context allows. Sustainable embedding requires ongoing support, interprofessional alignment, communication training and attention to the needs of diverse patient groups.
Registration
Registered on the Center for Open Science (OSF: https://osf.io/9dnyv/); additionally reviewed under METC N22-118 (non-WMO).
Features
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Project number:
10040022230016
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- Duration: 100%
Duration: 100 %20232025 - Part of programme:
- Related funding round:
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Project lead and secretary:
dr. MC. van der Linden PhD
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Responsible organisation:
Haaglanden Medisch Centrum
