Shift-to-shift handoffs in the NICU: lessons learned from a large scale audit

Area of Science:

• Neonatal Medicine
• Healthcare Quality Improvement
• Patient Safety

Background:

• Effective shift-to-shift handoffs are crucial for patient safety in the Neonatal Intensive Care Unit (NICU).
• Current best practices for NICU handoffs require consistent implementation and evaluation.
• Understanding variations in handoff communication is essential for quality improvement initiatives.

Purpose of the Study:

• To assess the frequency of best practice behaviors during NICU provider and nursing shift-to-shift handoffs.
• To identify specific strengths and areas for improvement in NICU handoff processes.
• To compare handoff behaviors between nurse-to-nurse and provider-to-provider communications.

Main Methods:

• An observational study was conducted across 40 NICU centers over 10 months.
• A standardized handoff audit tool, outlining best practices, was used for data collection.
• Data from 946 handoff audits were analyzed, comparing nurse and provider handoffs.

Main Results:

• While many handoff behaviors were consistently demonstrated, significant differences were observed between nurse-to-nurse and provider-to-provider handoffs.
• Families were present during 5.9% of observed handoffs.
• When present, families actively participated in 48.2% of handoffs by contributing information, asking questions, and sharing goals.

Conclusions:

• Measuring and observing handoff behaviors provides valuable insights for enhancing communication and family engagement.
• Auditing NICU handoffs is a feasible and necessary strategy to improve critical care transitions for infants.
• Addressing human factors and promoting family participation can optimize handoff effectiveness.