Clarity for Improving Standardized Obstetrician-Neonatologist Neonatal Handoffs [33Q]

Abstract

INTRODUCTION: There are currently no standardized methods of handoff between Labor & Delivery (L&D) and Neonatology teams for neonatology-attended deliveries. Communication breakdown occurs in approximately 70% of sentinel events resulting in perinatal mortality or permanent disability. Barriers to effective patient handoffs include confusion over role clarity, transferring unnecessary information, time constraints, and room volume. Standard communication in the delivery room could reduce communication variability and promote safer care. Our goal was to evaluate if standardized handoffs between the L&D and Neonatology teams in unplanned neonatology-attended cesarean deliveries would result in more complete and efficient transfer of critical patient information. METHODS: Members of the L&D and Neonatology teams were surveyed to determine critical areas of patient handoff in neonatology attended cesarean deliveries. Survey results were utilized to determine areas that required change for subsequent Plan-Do-Study-Act worksheets. Reliability of the process was assessed by Neonatology response respiratory therapists who submitted a separate observational survey. RESULTS: Over a 3 month period, 38 deliveries were assessed. The following transfer of critical information was identified: Obstetrician to Neonatologist - gestational age, single versus multiple gestation, presence of meconium, fetal heart rate abnormalities, fetal anomalies, and reason for the call. Whereas Neonatologist to Obstetrician - APGAR score, gender, birth weight, resuscitative measures, and disposition of infant. Both the L&D and Neonatology teams reported that a streamlined handoff process improved workflow and team satisfaction (15 and 16% positive increase, respectively). CONCLUSION: Standardization of handoffs and role identification improve communication of critical information between L&D and Neonatology teams.