Intervention Title:
Improving Staff Satisfaction and Patient Care by Creating an Electronic Change-of-Shift Report – the University of Texas M.D. Anderson Cancer Center, Houston, Texas

Goal:
Provide a more time-efficient, hands-off process for nurses during their shift change to improve nurse job satisfaction and save overtime costs.

Innovation:
Staff created a simple, electronic reporting system using Excel that nurses update with pertinent patient and treatment information at any time during their shift, rather than waiting until the end of their shifts to download this information verbally.

Result:
Nurse shift changes take less time, staff satisfaction has improved and the hospital is saving on overtime costs. Additionally, success of the pilot unit led to adoption in all of the hospital's inpatient units within several months.

Institution:
The University of Texas M.D. Anderson Cancer Center
1515 Holcombe Blvd. Box 82
Houston, TX 77030
P: (800) 392-1611

From the C-Suite:
“Shift change used to be a very tense time for our nurses, who need to get home to families or other personal obligations. By creating an electronic system, shift change became much more efficient, allowing staffers to go home on time and saving the hospital from unnecessary overtime costs.”

Barbara L. Summers, Ph.D., R.N.
Vice President and Chief Nursing Officer, Division of Nursing
The University of Texas M.D. Anderson Cancer Center

Profile:
The University of Texas M.D. Anderson Cancer Center is a 507-bed, comprehensive cancer center.

Clinical areas affected:

• All inpatient units

Staff involved:

• Clinical nurses
• Nurse leaders and managers
• IT staff

Timeline:
Staff conducted a three-month pilot test in one unit, and the system was later spread to all units one year later.

Contact:
Beverly A. Nelson M.S., R.N., C.N.A.A., B.C.
Director, Nursing Practice Programs
P: (713) 792-7112
banelson@mdanderson.org

Innovation implementation:
Patients often have complex needs that must be seamlessly communicated from one nurse to another at every shift change. With the old system, the nurses in the original pilot unit would meet in a conference room to pass all pertinent patient information from the outgoing nurse to the incoming nurse. These verbal exchanges of information added up to numerous overtime hours for nurses and, most predominantly, severe staff dissatisfaction. The nurses were generally unhappy because when the shifts ran long, they got charged for additional parking and were kept from family obligations.

To address these concerns, a resident nurse on the unit created an Excel spreadsheet to streamline the shift change process. She created categories of data within the spreadsheet that the nurse picking up the care of a patient would need to know. For instance, in the original pilot unit categories included demographic information, lab results, and information about other tests and medical orders.

The system saved the staff time by allowing nurses to enter patient information during the course of the shift instead of waiting until the end of the shift to share all patient information with the incoming nurse. It also resulted in less narrative and storytelling, which saved face-to-face communication for situations that really needed it and eliminated the “he said, she said” element of verbal communication.

Word of this intervention's success spread quickly, and other units began adopting the electronic change-of-shift report for their nurses. Within a few months, this intervention was spread throughout all inpatient units.

Advice and lessons learned:

1. Make the reporting mechanism foolproof. At this site, the staff's fear of a computerized system needed to be addressed. For instance, people were accidentally deleting the template on the pilot unit, so they had to enlist an IT staff member to install a more permanent, fail-safe version of the report—one that staff would feel confident using.
2. Determine up front what categories need to be included in the spreadsheet. The spreadsheet needs to be adapted and tested for each unit in order to ensure it captures the right information for that unit's patient population.

Cost/benefit estimate:
The unit saved roughly $80,000 per year by reducing overtime costs through the electronic shift change report. Staff satisfaction also greatly improved because the nurses could leave at their scheduled time.