Cambridge Memorial Hospital (ON)

  • Antonia Bartlett, Acting Vice President, Patient Services, Cambridge Memorial Hospital, Cambridge, Ontario

Transfer of Accountability: Managing Care Transitions to Enhance Patient Safety

This clinical initiative changed the traditional group change of shift report that occurred in the nursing conference room to a nurse-to-nurse verbal exchange at the patient’s bedside. Change of shift report is an integral part of a nurse’s daily routine, and it provides essential patient information to oncoming nurses. Shift report promotes patient safety, best practice and continuity of care through communication among nursing staff. Shift reports that lack a formal structure and guidelines can lead to inefficiencies and the sharing of irrelevant and inadequate information resulting in errors. Implementing a standardized and consistent Transfer of Accountability (TOA) process will promote and enhance patient safety, and create a more time-efficient process while improving the quality and relevance of information reported and improving patient outcomes. Also just having the nurses attend at the patient bedside at change of shift has resulted in increased patient satisfaction and reduced incidents. 

Through the development of a standardized bedside check-list and documentation tools to be utilized by all clinical departments we were successful in standardizing the process and expectations across the hospital. The communication and education to staff promoted and encouraged critical thinking to modify the process to meet department specific and individual patient needs. The development and institution of a corporate policy and procedure further reinforces compliance with TOA. 

The biggest challenge we faced was staff resistance to the change in practice. They were confident that the way they have always done things was effective and some did not see the need for change. They were uncomfortable doing the report at the bedside in front of the patient. They felt that bedside TOA would take longer and that they would be asked to stay longer at the end of their shift and that overtime costs would rise. It was important to value the present and not discount all the good work we currently do to promote patient safety. However, we were able to move them forward to adopt TOA through sharing of the evidence through evidence-based articles and reporting the current number of incidents both minor and serious that occur at transition points of a patient's care in our hospital. We also found that sharing the stories of near misses and incidents that have occurred related to an ineffective reporting process was a powerful tool. Enlisting their participation from the onset and utilizing peer opinion leaders as champions further promoted their engagement. The ability to pilot the initiative in a few clinical departments and make modifications to the process based on feedback was also helpful. Leadership presence at all phases of implementation reinforced the commitment to the initiative. 

The broader evidence to date shows positive outcomes related to the implementation of TOA in healthcare organizations, and although it is early in the Cambridge Memorial Hospital (CMH) TOA experience, the early reports demonstrate that TOA is having a positive effect on outcomes, and patient and staff satisfaction. Organizations that have not already done so should be encouraged to implement TOA as a patient safety initiative. Besides the obvious patient benefits, there will be financial benefits as well because reduced incidents can mean reduced length of stay resulting in reduced costs.