Abstract
INTRODUCTION: Beyond the provision of services, quality of care and patient safety measures such as optimal clinical handover at shift changes determine maternity outcomes. We aimed to establish the proportion of women handed over and the content of clinical handovers and communication between shifts within 3 diverse obstetrics units in Kerala, India, and to describe the handover environment.
METHODS: A cross sectional study was conducted for six weeks during February and March 2015at three hospitals in Kerala, India, during nurses obstetric handover in one tertiary private, one tertiary government and one secondary government hospital. Nursing handovers in obstetric post-operative, in-patient and labour wards were sampled. An SBAR-based (situation, background, assessment and recommendation) data schedule was completed whilst observing handover at nursing shift changes. Since obstetricians had no scheduled handover, qualitative interviews were conducted with obstetricians in two hospitals to establish how they acquire information when beginning a shift.
RESULTS: Data was obtained on 258 patients handed over, within 67 shift changes. The median percentage of women handed over was 100% in two of the hospitals and 27.6% in the other. The median number of information items included out of a possible 25 was 11, 5 and 4,and did not change significantly for women with high-risk status. Important items regarding assessment and recommendation for care were often missed, including high-risk status. The median number of environment items achieved was good at 7 out of 10 in all hospitals. Obstetricians sought information in various ways when required. All supported the development of structured tools, face-to-face and team handovers.
CONCLUSIONS: Maternity unit handovers for doctors and nurses were inadequate. Ensuring handover of all women and including critical information, between shifts as well as between doctors, needs to be improved to increase patient safety.
| Original language | English |
|---|---|
| Article number | e0268239 |
| Number of pages | 20 |
| Journal | PLoS ONE |
| Volume | 17 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 12 May 2022 |
Bibliographical note
Funding Information:This study was financed by an Intercalated Award funded by the Arthur Thompson Trust and by BMedSci Population and Health Sciences student funding. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. We would like to thank Dr Jon Ives, Professor Heather Draper and Dr Gilles de Wildt for their advice and support. We thank Dr Jonathan Bishop, Dr Sayeed Haque and Mrs Andrea Roalfe for their statistical expertise. We would like to thank the translators and hospital staff in all study sites for their cooperation and Jessica Dunphy for aiding in data collection.
Publisher Copyright:
Copyright: © 2022 Pilcher et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords
- Communication
- Cross-Sectional Studies
- Female
- Humans
- India
- Patient Handoff
- Patient Safety
- Pregnancy