title: Exploring perinatal shift-to-shift handover communication and process: an observational study.
abstract: OBJECTIVE
  Loss of situation awareness (SA) by health professionals during handover is a major threat to patient safety in perinatal care. SA refers to knowing what is going on around. Adequate handover communication and process may support situation assessment, a precursor of SA. This study describes current practices and opinions of perinatal handover to identify potential improvements.
  
  
  METHODS
  Structured direct observations of shift-to-shift patient handovers (n = 70) in an academic perinatal setting were used to measure handover communication (presence and order of levels of SA: current situation, background, assessment and recommendation) and process (duration, interruptions/distractions, eye contact, active inquiry and reading information back). Afterwards, receivers' opinions of handover communication (n = 51) were measured by means of a questionnaire.
  
  
  RESULTS
  All levels of SA were present in 7% of handovers, the current situation in 86%, the background in 99%, an assessment in 24% and a recommendation in 46%. In 77% of handovers the background was mentioned first, followed by the current situation. Forty-four per cent of handovers took 2 minutes or more per patient. In 52% distractions occurred, in 43% there was no active inquiry, in 32% no eye contact and in 97% information was not read back. The overall mean of the receivers' opinions of handover communication was 4.1 (standard deviation ± 0.7; scale 1-5, where 5 is excellent).
  
  
  CONCLUSIONS
  Perinatal handovers are currently at risk for inadequate situation assessment because of variability and limitations in handover communication and process. However, receivers' opinions of handover communication were very positive, indicating a lack of awareness of patient safety threats during handover. Therefore, the staff's awareness of current limitations should be raised, for example through video reflection or simulation training.
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Else P
authors.initials: EP
authors.lastname: Poot
authors.forename: Martine C
authors.initials: MC
authors.lastname: de Bruijne
authors.forename: Maurice G A J
authors.initials: MG
authors.lastname: Wouters
authors.forename: Christianne J M
authors.initials: CJ
authors.lastname: de Groot
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
mesh_terms: D000046:Academic Medical Centers; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008505:Medical Staff, Hospital / Q000458:organization & administration; D009741:Nursing Staff, Hospital / Q000458:organization & administration; D062209:Patient Handoff / Q000458:organization & administration* / Q000592:standards; D061214:Patient Safety; D018743:Perinatal Care / Q000458:organization & administration* / Q000592:standards; D011247:Pregnancy; D013647:Task Performance and Analysis; D013997:Time Factors
keywords: awareness; communication; continuity of patient care; handover; obstetrics and gynaecology; patient safety