Handoff quality for obstetrical inpatients varies depending on time of day and provider type

Abstract

Objective: To determine whether obstetric handoff quality differs morning versus evening, weekend versus weekday, or based on provider type.

Study design: Using the American College of Obstetricians and Gynecologists (ACOG) handoff guidelines, we developed an observational tool to assess whether handoffs included its 8 recommended elements. We observed handoffs between attending obstetricians, Obstetrics and Gynecology residents, labor and delivery nurses, and certified nurse midwives. Observation times included a balance of morning, evening, weekdays, and weekends. Participants were blinded to the study objectives. We defined high-quality handoffs as those that included 7 of the 8 recommended ACOG elements.

Results: A total of 425 inpatient handoffs were observed: 233 (55%) were morning handoffs and 189 (45%) were evening; 251 (59%) were on weekdays and 171 (41%) on weekends. Of the handoffs observed, 201 (48%) were presented by residents, 139 (33%) by nurses, 56 (13%) by attending obstetricians, and 26 (6%) by midwives. Only 169 (40%) of all handoffs met criteria for high quality. A greater percentage of all morning handoffs met criteria as compared to evening handoffs (45% vs. 34%, p < 0.05). There was no significant difference between the overall percentage of weekday and weekend handoffs meeting criteria (39% vs. 42%, p = 0.48). Residents had a higher percentage of high-quality handoffs as compared to nurses (55% vs. 32%, p < 0.001).

Conclusion: Based on criteria developed for this study, handoff quality may vary based on time of day and provider type. These findings present an opportunity to further assess reasons for variation and propose changes to standardize and improve the handoff process.