Overview of the Product or Service
Providing quality care is one of the primary goals of every clinical setting (Alvarado et al., 2006). Regardless of the clinical setting itself, patient care must remain the main focus for the organization: however, maintaining cost-effective procedures is also a key component of good clinical practice. Good patient care relies on the ability of the staff to communicate, as well as the ability of the organization to meet the specific needs of the patients (Alvarado et al., 2006). For clinical care centers that are open twenty-four hours a day, there can be problems with patient care when staff changes (Alvarado et al., 2006).
The purpose of this document is to discuss the cost and patient care ramificiations of a shift-change bedside reporting structure within the clinical care frameworks of an organization. When staff switch, critical information can be lost, and if a nurse is attending to a patient and must leave mid-procedure, other staff members need to know what the issues are that the nurse was dealing with specifically (Laws & Amato, 2010). However, despite the clear positive implications for the development and design of better handover shift change procedures, many clinical practices lack the structures necessary to guide staff in appropriate shift change reporting behaviors. It is the contention of this document that implementing specific nursing shift change bedside reporting standards will have a positive impact on the level of patient care experienced by patients within the organization, as well as on the costs accrued by the clinical organization as a whole (Laws & Amato, 2010; Alvarado et al., 2006).
Rationale
Clearly, when patients are in inpatient care—or even overnight care—they experience more shift changes than the average patient. When patients have to be inpatient for a long period of time, more people have to have knowledge of their case. The purpose for implementing the change of shift reporting structure is to standardize the reports given by staff members at the end of their shift. Currently, there are no structures in place, so any changes in cases are noted in charts and verbally expressed occasionally to new nurses coming in for their shift (Laws & Amato, 2010; Alvarado et al., 2006).
However, when these verbal reports do not happen, there is little that is available to help a nurse enusre that he or she has completed the work started on a case during the previous shift (Laws & Amato, 2010; Alvarado et al., 2006; Athwall, Fields & Wagnell. 2009). This can sometimes lead to mistakes in patient care, especially if it takes a long time for a nurse to be able to assess each and every one of his or her patients (Athwall, Fields & Wagnell. 2009). This also allows for a better transfer of accountability between nurses on each shift (Athwall, Fields & Wagnell. 2009). It makes sense, then, to discuss the potential cost-associated benefits of this policy, in the hopes of determining whether this kind of transfer of accountability policy is cost-effective and logical in the context of the current organization (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006).
Cost Implications
A very significant part of any healthcare organization’s budget is protection against malpractice and negligence. This comes in the form of insurance, but it also comes in the form of policies for patient care and safety that are put in place specifically to ensure that questions of patient safety do not arise (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006; Laws & Amato, 2010; Alvarado et al., 2006). The policy of bedside reporting in and of itself is positive for both patients and staff members.
Nurses are generally quite well-educated, and designing a program designed to help nurses learn appropriate bedside reporting techniques and processes is relatively simple and inexpensive. Training always costs some money—a budget must be created to either hire a professional trainer or pay a staff member to educate others, and to pay trainees for their time—however, training costs are minimal compared to potential malpractice threats (Athwall, Fields & Wagnell. 2009; Laws & Amato, 2010; Alvarado et al., 2006).
In addition, patients have more and more control over their own medical situation in recent years, so it makes sense to begin policies of bedside reporting to ensure that patients are well-acquainted with the details of improving their own care. It might take slightly longer, which could potentially be a cost for the clinical organization in overtime when applicable, but these instances are likely to be so minimal that they would be mostly negligible (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006; Laws & Amato, 2010; Alvarado et al., 2006). The process fosters a better relationship between the nurse and the paitent as well (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006). However, Alvarado et al. (2006) suggest that approximately 85% of bedside reports were completed between one and three minutes (Alvarado et al., 2006).
The costs for implementing this kind of structure would be quite fixed as well—once the policy is in place, training can be designed for existing employees as well as future recruits to the organization (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006; Laws & Amato, 2010; Alvarado et al., 2006). These training structures are likely to remain the same over time, and the organization does not need to adjust these policies very frequently, although they should be re-assessed on an annual or semi-annual basis (Alvarado et al., 2006). However, despite the need for re-assessment, there is no reason why the costs associated with this potential solution would vary.
Because costs associated with this potential policy would be quite fixed, there is no reason to be concerned that the cost of bedside reporting would increase year to year. This is likely to increase the protections for the organization against issues like threats to patient safety, which can be incredibly expensive for the organization as a whole (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006; Laws & Amato, 2010; Alvarado et al., 2006). Savings in costs associated with patient safety keeps the insurance rates low for the organization, and also protects the reputation of the organization. Malpractice suits, when they occur, can be linked to these key transitional times during patient care, where there are potential holes that the patient’s care can slip through (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006; Laws & Amato, 2010; Alvarado et al., 2006). To ignore the need for these kinds of policies is to open the organization up to suits associated with patients claiming malpractice, negligence, or even a failure to properly communicate the realities of care to the patient (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006; Laws & Amato, 2010; Alvarado et al., 2006).
Interestingly, the research also demonstrates that when nurses involve their patients in the process of treatment, patients respond more positively to the staff as a whole (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006; Laws & Amato, 2010; Alvarado et al., 2006). Patients who are involved in bedside reporting do not necessarily take a long time during each report, but the overall trend demonstrates a more engaged patient when he or she is expected to participate in the reporting process (Athwall, Fields & Wagnell. 2009).
If a hospital or clinical care center does experience a malpractice or negligence suit as a result of a mistake made during the transfer of care, that organization can face very serious ramifications. This is one of the primary costs that is shouldered by major medical organizations, as these organizations are responsible for the medical staff who are employed at the organization as a whole (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006; Laws & Amato, 2010; Alvarado et al., 2006). Unfortunately, even when these cases are unfounded they can be expensive; implementing these kinds of preventative tools can likely reduce the cost associated with legal claims.
Break Even Analysis
If the break-even point is defined as the fixed costs divided by the average price per person less the cost per person, then it seems clear that the amount spent on training can easily be offset by even one significant medical mistake during the year in patient care (Laws & Amato, 2010; Alvarado et al., 2006). Unfortunately, many mistakes occur during the transitional time between shifts for the nursing staff (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006; Laws & Amato, 2010; Alvarado et al., 2006).
Summary
Shift changes for nurses is one of the most critical times in patient care—all the evidence supports the fact that when handovers occur, errors in care are also more likely to be occurring (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006; Laws & Amato, 2010; Alvarado et al., 2006). However, despite this fact, many clinical settings do not have the appropriate models set up to encourage documentation and reporting during the transition between different shifts. The benefits of this particular process have been outlined in this report, and not all the benefits are related to cost. Many of the benefits are associated with patient care and the quality of patient care. Overall, this discussion demonstrated that there are indeed problems associated with implementing shift-change reports. However, despite these costs, it also finds that designing and implementing these reports, as well as training staff, is significantly less expensive over time than accuring costs related to malpractice or mistakes in patient care associated with shift-change mistakes (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006; Laws & Amato, 2010; Alvarado et al., 2006).
Nurses play a very critical role in the experience of a patient, regardless of the reason why the patient is in the clinical setting. As such, nurses need to be more engaged with their patients, and they must be certain that they can act as an effective advocate for their patient, even when they have first come on duty. Information about changes in a patient’s case or even mood changes during the day can be very important and useful information for a nurse who is just coming on duty (Athwall, Fields & Wagnell. 2009; Anderson & Mangino, 2006; Laws & Amato, 2010; Alvarado et al., 2006).
References
Alvarado, K., Lee, R., Christoffersen, E., Fram, N., Boblin, S., Poole, N., & Forsyth, S. (2006). Transfer of accountability: transforming shift handover to enhance patient safety. Healthcare Quarterly, 9(Sp).
Anderson, C. D., & Mangino, R. R. (2006). Nurse shift report: who says you can't talk in front of the patient?. Nursing administration quarterly, 30(2), 112-122.
Athwal, P., Fields, W., & Wagnell, E. (2009). Standardization of Change‐of‐Shift Report. Journal of nursing care quality, 24(2), 143-147.
Laws, D., & Amato, S. (2010). Incorporating Bedside Reporting into Change‐of‐Shift Report. Rehabilitation Nursing, 35(2), 70-74.
