title: Gaps in continuity of care: patients' perceptions of the quality of care during labor ward handover in Mulago hospital, Uganda.
abstract: BACKGROUND
  Client satisfaction is a common outcome measure for quality of care and goal for quality improvement in healthcare. We assessed women's perceptions of the structure, process and outcome of intrapartum care in Mulago hospital, specifically, labor ward duty shift handovers.
  
  
  METHODS
  Data was collected through 40 in-depth interviews conducted on two occasions: during the time of hospitalization and within 4-6 months after childbirth. Participants were women who delivered at the hospital, of whom some had life-threatening obstetric complications. Data was analyzed by thematic analysis.
  
  
  RESULTS
  Maternity duty handovers were associated with patient dissatisfaction, particularly the process of hand-over, the decision-making that follows handovers and failure of communication of information to patients and their caretakers. Consequently, duty handovers were perceived inadequate. They were described as gaps in the continuity of care, and contributed to poor quality of care, birth trauma and mothers' dissatisfaction with the childbirth experience.
  
  
  CONCLUSIONS
  The handover process and practices should be standardized using protocols and checklists. Health workers need training on handover practices, team work and communication skills (so as to improve patient-health provider and provider-provider interaction.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda. dankkaye@yahoo.com.
authors.forename: Dan K
authors.initials: DK
authors.lastname: Kaye
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda. annettee.nakimuli@gmail.com.
authors.forename: Annettee
authors.initials: A
authors.lastname: Nakimuli
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda. kakaireothman@gmail.com.
authors.forename: Othman
authors.initials: O
authors.lastname: Kakaire
authors.affiliation: Department of Obstetrics and Gynecology, Jinja Regional Hospital, Jinja, Uganda. omoggg@yahoo.com.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Osinde
authors.affiliation: Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda. snmbalinda@gmail.com.
authors.forename: Scovia N
authors.initials: SN
authors.lastname: Mbalinda
authors.affiliation: Clinical, Operations and Health Services Research Program, Joint Clinical Research Centre, P. O. Box 10005, Kampala, Uganda. kakandeivan@yahoo.com.
authors.forename: Nelson
authors.initials: N
authors.lastname: Kakande
mesh_terms: D003266:Continuity of Patient Care / Q000592:standards*; D003657:Decision Making; D036861:Delivery, Obstetric; D005260:Female; D006282:Health Personnel; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D007743:Labor, Obstetric; D017063:Outcome Assessment, Health Care; D062209:Patient Handoff; D017060:Patient Satisfaction; D011247:Pregnancy; D036301:Qualitative Research; D011787:Quality of Health Care; D014454:Uganda