Improving handovers between the Birth Units and Delivery Suite

Quality Improvement Poster Download

Background & Problem

It is known that ineffective information transfer at handover contributes to unsafe care in maternity (Kings Fund 2012). Standardised handover tools such as RSVP (Reason, Summary, Vital information [signs], Plan) and SBAR (Situation, Background, Assessment, Recommendations) have been adopted locally and regionally to improve information transfer. Recent local maternity audit (December 2015) demonstrated that our current handover tool, the RSVP sticker, was not well used (45 out of 100 randomly selected maternity notes form all clinical areas).

Following a poor clinical outcome after transfer between a birth unit and delivery suite, one mother requested that her story be used to improve maternity care. This feedback was the catalyst that inspired this service improvement project to try and improve handover in the future.

Aim

To improve the quality of handover of care when women are transferred from a birth unit to delivery suite. Documented handovers will be scored against set criteria; we aim to improve scores by 30% in the first three months following the introduction of a new handover tool.

Method

It is recognised that it is possible to handover care in many ways: verbally, using structured tools, or via case notes. In light of this, various methodologies were considered: observational audit, focus groups, self reporting etc. For pragmatic reasons it was decided to develop and introduce a new standardised handover proforma and audit effectiveness of handovers pre and post introduction of tool. PDSA cycles were central to developing the new handover tool. Case note audit will assess handovers against set criteria, to demonstrate improvement.

Results

Our baseline audit findings show inconsistent quality of handover, with a wide range of tools being used with varying levels of success. Although the new pro forma has not yet been introduced, It is hoped that it will result in handovers that are more structured, standardised, and informative and overall of higher quality.

Implications

Development of the new handover proforma has been controversial. Opportunities exist to improve information transfer through education as well as further developing handover tools. There is opportunity to cascade this work in a variety of clinical settings and specialties.