Rapidly changing labor statuses and resident work hour restrictions resulting in multiple patient care transitions make obstetrical handoffs vulnerable to significant errors that may result in medical misfortunes. This study aimed to train obstetrical residents to improve handoffs using the novel mnemonic “SWIFT”: Subject, Why?, Issues, Fetus, Tasks.
A needs-assessment survey of obstetrics residents was performed. Resident labor-floor handoffs were recorded with a hidden voice recorder before and after didactic sessions, and after replacing the whiteboards used at shift turnover with ones formatted with the mnemonic SWIFT. Attending obstetricians blinded to timing and speaker identity evaluated handoff transcripts. An intraclass correlation coefficient accounted for evaluator differences. Data analysis was by ordinal logistic regression, the GEE method (for correlated data) and Bonferroni adjustment (for multiple comparisons).
Forty-five individual handoffs were evaluated (15 each pre-didactics, post-didactics and post-whiteboard revision). Over time, higher completeness scores over were noted for admission reason, labor concerns, and task list, and comprehensive score increases were seen in handoff clarity (2.81 vs 2.91) and overall quality (2.77 vs 2.81) but none were significant. A subanalysis of four residents who gave multiple handoffs over different time periods revealed few changes over time. Greater inter-evaluator consistency was noted with more objective elements.
The mnemonic SWIFT may be helpful in obstetrical handoffs. Formalized curricula for obstetrical resident training, focusing on new learners, with increased faculty involvement and reinforcement may result labor floor handoff improvements and fewer medical errors.
Columbia University Medical Center, Jamaica, NY
Financial Disclosure: The authors did not report any potential conflicts of interest.