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Shift-to-shift handoffs in the NICU: lessons learned from a large scale audit

Journal of Perinatology volume 43, pages 1468–1473 (2023)Cite this article

Subjects

Abstract

Objective

Describe the frequency of best practice behaviors during NICU provider and nursing shift-to-shift handoffs and identify strengths and opportunities for improvement.

Study design

Observational study of handoff characteristics among 40 centers participating in a learning collaborative over a 10-month period. Data were gathered using a handoff audit tool that outlined best practices. Comparisons of behaviors between nurse-to-nurse and provider-to-provider handoffs were made where appropriate.

Results

Overall, 946 audits of shift-to-shift handoffs were analyzed. While many behaviors were demonstrated reliably, differences between nurse-to-nurse vs provider-to-provider handoffs were noted. Families were present for 5.9% of handoffs and, among those who were present, 48.2% participated by contributing information, asking questions, and sharing goals.

Conclusions

Observation and measurement of handoff behaviors can be used to identify opportunities to improve handoff communication, family participation, and human factors that support handoff. Auditing handoffs is feasible and necessary to improve these critical transitions in infants’ care.

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Data availability

The data that support the findings of this study are available from the Vermont Oxford Network (VON) but restrictions apply to the availability of these data, which were used in accordance with the terms for data use between participating centers and VON, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the Vermont Oxford Network.

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Acknowledgements

We thank the centers that participated in iNICQ. A list of centers that contributed data to this analysis is found in Supplement 5.

Funding

DZ, RFS, and KAM are employees of the Vermont Oxford Network (VON). EME is funded by a grant from VON to the University of Vermont. HCK, JM, WT, HC, ES, and MF have served as paid faculty for VON.

Author information

Authors and Affiliations

  1. Perinatal Institute, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Heather C. Kaplan

  2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Heather C. Kaplan

  3. Division of Neonatology, University of Massachusetts Chan Medical School, Worcester, MA, USA

    Wendy Timpson

  4. Division of Neonatology, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, NY, USA

    Jeffrey Meyers

  5. Children’s Hospital of Colorado, Aurora, CO, USA

    Elizabeth Schierholz

  6. Randall Children’s Hospital, Portland, OR, USA

    Howard Cohen

  7. Akron Children’s Hospital, Akron, OH, USA

    Marybeth Fry

  8. Vermont Oxford Network, Burlington, VT, USA

    Denise Zayack, Roger F. Soll, Kate A. Morrow & Erika M. Edwards

  9. Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, USA

    Roger F. Soll & Erika M. Edwards

  10. Department of Mathematics and Statistics, University of Vermont, Burlington, VT, USA

    Erika M. Edwards

Authors
  1. Heather C. Kaplan
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  2. Wendy Timpson
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  3. Jeffrey Meyers
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  4. Elizabeth Schierholz
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  5. Howard Cohen
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  6. Marybeth Fry
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  7. Denise Zayack
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  8. Roger F. Soll
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  9. Kate A. Morrow
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  10. Erika M. Edwards
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Contributions

HCK substantially contributed to the conception and design of the work, analyzed and interpreted the data, drafted the initial manuscript, created the tables, and critically revised the manuscript for important intellectual content. EME and KAM substantially contributed to the analysis and interpretation of the data and critically revised the manuscript for important intellectual content. JM, WT, HC, ES, RFS, MF, and DZ substantially contributed to the conception and design of the work and critically revised the manuscript for important intellectual content.

Corresponding author

Correspondence to Heather C. Kaplan.

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The authors declare no competing interests.

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Kaplan, H.C., Timpson, W., Meyers, J. et al. Shift-to-shift handoffs in the NICU: lessons learned from a large scale audit. J Perinatol 43, 1468–1473 (2023). https://doi.org/10.1038/s41372-023-01724-2

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