Obstetric shift-to-shift handover in Kerala, India: A cross-sectional mixed method study

Area of Science:

• Obstetrics and Gynecology
• Healthcare Quality Improvement
• Patient Safety Research

Background:

• Quality of care and patient safety, including clinical handover, significantly impact maternity outcomes.
• Effective communication during shift changes is crucial in obstetrics units.

Purpose of the Study:

• To determine the proportion of women handed over during shift changes in diverse obstetrics units in Kerala, India.
• To assess the content of clinical handovers and communication between shifts.
• To describe the handover environment in these units.

Main Methods:

• A cross-sectional study observed 67 nursing shift changes across three hospitals (tertiary private, tertiary government, secondary government) in Kerala.
• An SBAR-based data schedule was used to collect data on handover content and patient proportion.
• Qualitative interviews were conducted with obstetricians to understand their information acquisition methods.

Main Results:

• A median of 100% of women were handed over in two hospitals, but only 27.6% in another.
• The median number of information items included in handovers was low (11, 5, and 4), with critical data often omitted, even for high-risk patients.
• The handover environment was generally good (7/10 items), but obstetricians lacked structured handover processes.

Conclusions:

• Maternity unit handovers for both doctors and nurses were found to be inadequate.
• Improvements are needed in ensuring all patients are handed over and critical information is consistently communicated between shifts and between doctors to enhance patient safety.