Clinician responsibility is confused during maternity handovers

By Sarah Guy, medwireNews Reporter

There is a lack of consensus around the transfer of responsibility and accountability during handovers between clinicians working in maternity care, show findings from an Australian study.

Some of the midwives, obstetricians, neonatal clinicians, anesthetists, physicians, mental health clinicians, and nursing bed managers who were surveyed for the study believed that the end of a shift, or when the clinician had physically left the building, signaled the transfer of responsibility.

However, some respondents felt that responsibility and accountability could continue after handover, if they felt that the handover was inadequate, that they had more information to add, or that they were responding to an emergency if oncoming staff were unavailable, report the researchers.

"It is important that on each shift and new workplace environment clinicians agree upon primary role definitions, responsibilities and accountabilities for patients," write Georgiana Chin (Monash University, Melbourne, Victoria) and co-investigators in BMJ Open. "This is a keystone to safe clinical care," they add.

The team carried out interviews and focus groups with 91 of the above-mentioned maternity clinicians working at a 5000-births-per-annum hospital during 2007, to evaluate perceptions of handover, particularly while patients are in active labor.

Just seven participants spontaneously identified the transfer of responsibility and/or accountability as one of the roles of handover, but all others agreed it was connected to handover when prompted.

The end of the handover communication (ie, conversation), the end of rostered time of duty, and the clinician leaving the workplace were some of the definitions given for handover, while others believed responsibility and accountability was achieved when a clinician of equal seniority had received the handover.

Extended personal clinical knowledge of the patient and direct involvement in her care both induced some clinicians to feel an ongoing moral responsibility for her beyond clinical handover.

One junior obstetric doctor said: "If I have been with the patient full time and this patient is in 2nd stage [labor] and is very close to delivery after 20 hours... occasionally I feel that I carry full responsibility."

"Role confusion, uncertainty of allocation of work, and identification of the appropriate person for reporting," all have the potential to lead to problems, and these elements should be "agreed upon and established at each shift and/or handover," conclude the authors.

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