So Fresh and So CLEAN: Improving Handoff Through Collaboration

The Clinical Scene Investigator (CSI) Healthy Work Environments Go Big Initiative nursing team, based in the trauma and surgical intensive care unit at Oregon Health and Science University, implemented evidence-based strategies focused on improving their unit’s American Association of Critical-Care Nurses Healthy Work Environment Assessment Tool (HWEAT) scores, nurse turnover rate, incremental overtime, and central line [catheter]–associated bloodstream infection (CLABSI) rates through better handoff communication.Nurses assessed team dynamics using the HWEAT, which identified areas for improvement in True Collaboration and Skilled Communication. To standardize handoff reports, the team developed the acronym CLEAN: Cares (external ventricular drain, collar, catheter, dressing), Lines (labeled, dated, traced, adequate volume), Empty (counter, supplies, trash/linen if less than half full), Admit preparation (room ready for new patient), and Nonnegotiables (time-sensitive medications/imaging). Promotional materials, one-on-one education, and audits tracked progress, improving collaboration and communication, while ensuring consistent, high-quality patient care. A postintervention HWEAT survey was used to evaluate outcomes.To ensure long-term sustainability, the team integrated the CLEAN education into new hire and travel nurse orientations and explored expanding the initiative across all critical care services.The CSI nursing team enhanced patient outcomes and teamwork by leveraging the HWEAT results to develop and implement a standardized handoff report, CLEAN. This initiative led to no change in nursing staff turnover, a reduction in incremental overtime, and a substantial reduction in CLABSI rates. Also, True Collaboration and Skilled Communication HWEAT scores improved.