Abstract
BackgroundMaternity clinical handover serves to address the gaps in knowledge existing when transitions between individuals or groups of clinicians occur throughout the antenatal, intra-partum and postnatal period. There are limited published studies on maternity handover and a paucity of information about patients' perceptions of the same. This paper reports postnatal patients' perceptions of how maternity handover contributes to the quality and safety of maternity care.MethodsThis paper reports on a mixed-methods study consisting of qualitative interviews and quantitative medical record analysis. Thirty English-speaking postnatal patients who gave birth at an Australian tertiary maternity hospital participated in a semi-structured interview prior to discharge from hospital. Interview data were coded thematically using the constant comparative method and managed via NVivo software; this data set was supplemented by medical record data analysed using STATA.ResultsAlmost half of the women were aware of a handover process. Clinician awareness of patient information was seen as evidence that handover had taken place and was seen as representing positive aspects of teamwork, care and communication by participants, all important factors in the perception of quality health care. Collaborative cross-checking, including the use of cognitive artefacts such as hand held antenatal records and patient-authored birth plans, and the involvement of patients and their support people in handover were behaviours described by participants to be protective mechanisms that enhanced quality and safety of care. These human factors also facilitated team situational awareness (TSA), shared decision making and patient motivation in labour.ConclusionsThis study illustrates that many patients are aware of handover processes. For some patients, evidence of handover, through clinician awareness of information, represented positive aspects of teamwork, care and communication.Cross-checking and cognitive artefacts were observed to support handover. Patient-authored birth plans were described by some to enhance the quality and safety of the handover by providing a 'voice' to the patient in this process. This was a novel and potentially important perspective.Future research involving patients and their support people in supporting and evaluating handover should be considered.
Highlights
IntroductionMaternity care predominantly involves the care of healthy, low-risk women and their babies for a defined period of normal physiologic change (pregnancy, birth and transition to the non-pregnant state)
Maternity clinical handover serves to address the gaps in knowledge existing when transitions between individuals or groups of clinicians occur throughout the antenatal, intra-partum and postnatal period
Demographics and clinical information The majority of the participants in this study were inpatients following the birth of their first child (Table 1) and this was first personal experience of maternity handover
Summary
Maternity care predominantly involves the care of healthy, low-risk women and their babies for a defined period of normal physiologic change (pregnancy, birth and transition to the non-pregnant state). This is not always the case, and levels of risk are influenced by medical conditions that pre-exist or develop during the Transitions of care occur throughout the whole continuum of pregnancy. They occur between multiple health professionals antenatally (such as occurs in shared antenatal care, midwifery-led models of care and between outpatient departments), intra-partum (within labour) and in transitions of care between wards, theatre and the community on post-natal discharge from hospital. Communication is paramount to enhance the safety and quality of these transitions [6]
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