Standardizing Handoffs in Labor and Delivery: Encouraging findings from a grassroots process
Abstract Number: S-10
Abstract Type: Original Research
Background: Teamwork and communication failures in Labor and Delivery (L&D) are leading causes of patient harm. Prior literature cites increased birth injuries during times of nursing shift change. Despite growing research activity, a robust evidence base to support a best practice for handoff standardization is lacking. The goal of this study was to evaluate the psychometric properties and demonstrate the utility of a new instrument for assessing the quality of handoffs among L&D nurses, CHEQ (Coordination of Handoff Effectiveness Questionnaire).
Methods: CHEQ incorporated three existing scales on teamwork, job satisfaction, and burnout, and included two new scales (handoff information quality and handoff process quality) developed for the purposes of this study. All items in CHEQ use a 1-5 (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5 strongly agree) Likert scale. CHEQ was administered pre-and-post implementation of a standardized handoff intervention.
Results: Chronbach’s Alphas demonstrated good to outstanding internal reliability for all scales both pre-and-post (Figure 1). After implementation of the intervention, teamwork climate improved significantly, burnout decreased significantly, and handoff information quality and handoff process quality both improved. Job satisfaction was not significantly different. Archival data revealed increased compliance with antenatal steroid administration from 85.9% pre-intervention to 98.5% post-intervention.
Conclusion: The tangible handoff tool significantly improved the process and information quality of nurse handoffs in L&D. Furthermore, a statistically significant increase in teamwork climate and a concomitant decrease in self-reported burnout among L&D nurses were observed. Although not statistically significant, job satisfaction trended upward. This tool provides a practical and psychometrically sound metric for use in handoff projects and offers insights into the nuances of shift change and intrashift handoffs. Future work could examine the relationship between improved handoffs and clinical and operational outcomes.
(1) Bailit JL et al. Maternal-Fetal Medicine Units Network Cesarean Registry: impact of shift change on cesarean complications. Am J Obstet Gynecol 2008; 198:173-177.
(2) Sexton J.B., et al. Variation in Caregiver Perceptions of Teamwork Climate in Labor and Delivery Units. J Perinatol. 2006 Aug;26(8):463-70.