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

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.

Factors contributing to inaccurate diagnosis code in obstetric case in hospital

“…It is widely recognized that code accuracy is crucial for hospitals, especially BPJS hospitals (hospitals that in collaboration with BPJS program), yet some hospitals continue to struggle with poor coding practices. Errors in coding obstetric cases will certainly have a major impact on hospitals (Pilcher et al, 2022), precisely in financing the INA-CBG's system (Arpit & Yulia, 2020).…”

Nurses' Versus Physicians' Perceptions of the Bedside Handover Practice in the Intensive Care Unit

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“…Besides, physician-to-physician handoffs are of equal or even more importance and have also been identified as a high-risk area of patient care 9. Limited studies have been conducted on the process and communication in nursing handovers in a single study 10…”

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“…Terkait hal ini perawat menemukan SBAR menjadi alat yang sangat berguna untuk meningkatkan keselamatan pasien dan kerja tim. Selain itu, penelitian lain menunjukkan bagaimana SBAR dapat diterima oleh residen pengobatan darurat karena memfasilitasi komunikasi dalam pengaturan klinis antara dokter dan program pelatihan residensi (Pilcher et al, 2022). Akibatnya dalam proses komunikasi sangat diperlukan SBAR yang telah terbukti meningkatkan kelangsungan hidup rumah sakit (Sharp et al, 2019).…”