A national survey of obstetric anaesthetic handovers*

Abstract

SummaryThe handover of patient information between shifts enables continuity of care and increases patient safety. We surveyed UK practice during handovers in obstetric anaesthesia. A questionnaire was sent to 239 lead consultant obstetric anaesthetists to record routine practice in their unit and individual opinion about handover procedures. Responses were received from 168 anaesthetists, a 70% response rate. Handover policies were available in 10% of units. Most (76%) responding units had an allocated time for handover. In most units (76%), the duration of handover was reported as being < 15 min but the actual duration and depth of any discussion involved were not specified. Handovers were rarely documented in writing (7%). Consultant anaesthetists were most likely to be present at the morning handover and few handovers were multidisciplinary. Four percent of units reported critical incidents following inadequate handovers in the past 12 months. We identify features in handover procedures that could be improved. In the UK, guidance from the Department of Health [1] and Association of Anaesthetists of Great Britain and Ireland [2] emphasises the importance of accurate, documented handover between members of staff. One factor that has made the effectiveness of handovers imperative is the increase in the number of times a day handovers are required, as trainees' working practices have changed following the New Deal and the European Working Time Directive [3,4]. Anaesthetists exchange information on various levels every day [5] across their own professional work and with other specialists and healthcare colleagues. In obstetrics, this contact will mainly be with the obstetricians, midwives and neonatologists. Opportunities for misunderstandings and error are always present and may occur because assumptions are made that go unchecked. These increase the risks of adverse events and potential litigation. One of the main potential structures for preventing this is good communication during handover [1]. It is during handover, particularly if it is multidisciplinary, that issues can be discussed, leading to a framework for effective patient management.A recent survey of UK anaesthetic departments found that few had structured handover procedures, although most respondents felt that they were needed [6]. However, this survey excluded obstetric anaesthesia, an area of high clinical and organisational risk, and typically one that involves frequent changes of staff. In such an environment it is particularly important that information be handed over between staff of the same discipline and also between the different disciplines. Childbirth remains a significant cause of morbidity and mortality in otherwise healthy, young women and this risk is increased in women with pre-existing medical disorders [7]. Thus, the transfer of accurate and sufficient medical and social information to labour ward staff is vital to protect vulnerable women. The importance of this has been highlighted in other sectors as well as health care. For ...

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