"Let's chat" is a phrase we have all used for years. Maybe you have a chat with your grandmother every Sunday or a chat with your coworkers after a monthly meeting. The relevance and prevalence of the word were not lost on us as we began our initiative to introduce bedside reporting for RNs in the ED.
Located in an urban area, our 28-bed ED treats about 54,000 patients annually. The following discussion explains how the acronym "CHAT" served as a framework for our new reporting process.
Talking points
In a continuing effort to improve patient satisfaction, nurses in the department decided to focus on communication. They sensed that patients and their families might get lost in the shuffle as they received care in a very busy ED.
According to the National Patient Safety Foundation (NPSF), giving a bedside report improves and promotes both patient safety and the practice environment for nurses.1 We believed bedside reporting would increase professionalism and teamwork in our ED by providing initial contact between the patient and the care team, giving nurses the opportunity to gather baseline patient data, helping nurses prioritize care, and assessing patient safety risks. As an additional benefit, we anticipated that bedside report would increase staff accountability through real-time conversations, added time with patients, and mentoring opportunities for new nurses.2
In April 2010, armed with this knowledge, we decided to develop a process of bedside reporting to boost nurse and patient satisfaction in our ED. Initially, we conducted an anonymous informal survey of RNs to determine their satisfaction with the current method(s) of shift reporting. Armed with the supportive data from the survey, we developed the acronym CHAT, which stands for communicate/clear, history, assessment/actions, and treatment plan/thank you, and a process for following it. Teaser e-mails were sent to staff over a 2-week period to generate interest. Via e-mail and a poster session, we introduced and outlined the new process.
CHAT is a 10-minute handoff conducted at the beginning of each shift, and the incoming and outgoing nurses share responsibility for finishing uncompleted tasks and/or orders. It requires prompt reporting at the beginning of the shift. Nurses may share exceptional information, such as police involvement, social issues, or diagnoses not yet relayed to the patient outside of the room following CHAT completion.
As with any new initiative, the process faced challenges from those who preferred to keep things the way they were. Many of our nurses were reluctant, for example, to provide a bedside report for patients who regularly came into the ED or patients who were intoxicated.
The CHAT process is a work in progress, so we continue to gauge how well we are doing on a regular basis. Staff education about the CHAT process now occurs in ED nurse residency and new hire classes; it is now an expectation for care in our department and beyond.
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