Clinical handover communication at maternity shift changes and women's safety in Banjul, the Gambia: a mixed-methods study

Abstract

Background Clinical handover is a vital communication process for patient safety; transferring patient responsibility between healthcare professionals (HCPs). Exploring handover processes in maternity care is fundamental for service quality, addressing continuity of care and maternal mortality. Methods This mixed-methods study was conducted in all three maternity hospitals in Banjul, The Gambia. Shift-to-shift maternity handovers were observed and compared against a standard investigating content and environment. Semi-structured interviews and focus group discussions with doctors, midwives and nurses explored handover experience. Results One hundred ten nurse/midwife shift-to-shift handovers were observed across all shift times and maternity wards; only 666 of 845 women (79%) were handed over. Doctors had no scheduled handover. Shift-leads alone gave/received handover, delayed [median 35 min, IQR 24–45] 82% of the time; 96% of handovers were not confidential and 29% were disrupted. Standardised guidelines and training were lacking. A median 6 of 28 topics [IQR 5–9] were communicated per woman. Information varied significantly by time, high-risk classification and location. For women in labour, 10 [IQR 8–14] items were handed-over, 8 [IQR 5–11] for women classed ‘high-risk’, 5 [IQR 4–7] for ante/postnatal women (p < 0.001); > 50% had no care management plan communicated. Twenty-one interviews and two focus groups were conducted. Facilitators and barriers to effective handover surrounding three health service factors emerged; health systems (e.g. absence of formalised handover training), organisation culture (e.g. absence of multidisciplinary team handover) and individual clinician factors (e.g. practical barriers such as transportation difficulties in getting to work). Conclusion Maternity handover was inconsistent, hindered by contextual barriers including lack of team communication and guidelines, delays, with some women omitted entirely. Findings alongside HCPs views demonstrate feasible opportunities for enhancing handover, thereby improving women's safety.

Safety culture in maternity hospital: Perception of nurse‐midwives

“…As shift changeover is one of the essential moments for learning and continuity of care, as mentioned by the nurse managers in the study of Fassarella et al. (2021), shift handover should be included in training to promote staff motivation and awareness of potential risks of short, inaccurate or incomplete handovers, often aggravated by lack of time and reduced human resources (Rickard et al., 2022). The same author mentioned in his study that professionals advocate for standardized guidelines and protocols, applying tools such as ISBAR (introduction, situation, background, assessment and recommendation), for efficient communication and reduction of adverse events because they consider that it will improve the quality and content of handover moments in the maternity ward (Rickard et al., 2022).…”

Cultura De Segurança Na Prática Clínica Dos Enfermeiros Obstetras

“…Todavia, quando falamos de comunicação, não podemos esquecer a dimensão "transferências e transições hospitalares" que, apesar de obter uma porcentagem média de respostas positivas com um score de 57,8%, é uma área que necessita de intervenções de melhoria 25 . Os profissionais de saúde defendem diretrizes e protocolos padronizados para comunicação eficiente do conteúdo das transferências nos serviços de obstetrícia, pois conhecem os riscos potenciais de transferências curtas, imprecisas ou incompletas, muitas vezes agravadas pela falta de tempo e recursos humanos reduzidos 29 .…”

Safety Culture in Obstetric Nurses' Clinical Practice

“…However, when we talk about communication, we cannot forget the "hospital handoffs and transitions" dimension which, despite obtaining a mean 9/15 percentage of positive answers with a score of 57.8%, is an area that needs improvement interventions 25 . Health professionals advocate standardized guidelines and protocols for efficient communication of the content of handoffs in obstetrics services, as they are aware of the potential risks of brief, inaccurate or incomplete handoffs, oftentimes aggravated by lack of time and reduced human resources 29 .…”