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From handover to takeover: should we consider a new conceptual model of communication?

02 March 2020
19 min read
Volume 28 · Issue 3



This service evaluation aimed to collect data on clinical handover on labour ward and compare them with the local guideline.

Design and methods

This service evaluation was structured in four stages, each using a different design and research methods.


The study was undertaken between September 2013 and August 2014 in a maternity unit in a large NHS teaching hospital in London, UK.

Findings and conclusion

Communication breakdown is widely considered to be a significant factor contributing to poor patient outcomes, with handover being a major risk point. The discrepancy between the local guideline and current clinical practice reinforces the belief that urgent action is needed to improve clinical handover on labour ward. The results of this service evaluation suggest that a drastic overhaul of the communication model during handover should be considered, ie from handover to takeover, and that the mnemonic SBAR may not be fit-for-purpose in maternity care and should be replaced with a different format that reflects the chronological flow of clinical events.

Clinical handover has long been an important topic among both clinicians and academics interested and involved in patient safety in healthcare. It is widely recognised that clinical handover represents a vital, yet vulnerable, link in the chain, ensuring continuity of care for all patients during their hospital stay (Ong and Coiera, 2011; Scott et al, 2012; ten Cate and Young, 2012; Moore, 2012).

Extensive knowledge has also been imported from other high-risk industries, such as aviation, nuclear power and the armed forces, and adapted for use within healthcare settings (Gaba, 2000; Singh, 2009; Kapur et al, 2016). However, to date, very little is known about what can be considered to be best evidence-based practice in clinical handover on labour ward (Spranzi, 2014). Childbirth is a unique event in life. In the UK, childbirth is expected to have a positive outcome, both for mother and infant. Overall, the provision of maternity care in the UK is considered of an excellent standard. Current figures for England and Wales show neonatal mortality rate at 2.7 per 1 000 live births (Office for National Statistics, 2018). Some of these deaths may be unavoidable; however, some may be preventable.

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