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A SWIFT Method for Handing Off Obstetrical Patients on the Labor Floor

Sheen, Jean-Ju MD*; Reimers, Laura PhD; Govindappagari, Shravya MD*; Ngai, Ivan M. MD; Garretto, Diana MD; Donepudi, Roopali MD§; Tropper, Pamela MD, MPH; Goffman, Dena MD*; Dayal, Ashlesha K. MD; Bernstein, Peter S. MD, MPH

doi: 10.1097/PTS.0000000000000377
Original Article: PDF Only

Objective The aim of this study was to improve patient handoffs on the labor floor.

Methods A prospective cohort study of obstetrics residents at Montefiore Medical Center was performed between 2012 and 2014. Labor-floor handoffs were recorded before and after didactic sessions as well as after installation of whiteboards formatted with the mnemonic SWIFT (Subject, Why?, Issues, Fetus, Tasks). Handoff transcripts were evaluated by obstetricians blinded to timing and speaker identity. An intraclass correlation coefficient accounted for evaluator differences. Data analysis was by ordinal logistic regression, the generalized estimating equations method (correlated data), and Bonferroni adjustment (multiple comparisons).

Results Forty-five handoffs were evaluated (15 each predidactics, postdidactics, and postwhiteboard revision). Higher completeness scores over time were noted for admission reason, labor concerns, and task list (not statistically significant). Comprehensive score increases prelecture to postwhiteboard were seen in handoff clarity (2.81 versus 2.91) and overall quality (2.77 versus 2.81) (not statistically significant). A subanalysis of four residents who gave multiple handoffs over different periods revealed few significant changes over time. Greater interevaluator consistency was noted with more objective elements.

Conclusions The mnemonic SWIFT, with formalized curricula for obstetrical resident training focusing on new learners and increased faculty involvement and reinforcement, may result in improvement of handoffs on the labor floor.

From the *Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; †Department of Obstetrics and Gynecology & Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine of Yeshiva University, Bronx, NY; ‡Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook Medicine/Stony Brook University Hospital, Stony Brook, NY; and §Department of Obstetrics, Gynecology and Reproductive Sciences, Children's Memorial Hermann Hospital/McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX.

Correspondence: Jean-Ju Sheen, MD, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W 168th St PH16-66, New York, NY 10032 (e-mail: js4596@cumc.columbia.edu).

The authors disclose no conflict of interest.

This study was supported by the American College of Obstetricians and Gynecologists and the Salus Global MORE OB Patient Safety in Obstetrics research award.

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