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Chapter 32: Transition of Care

Yunping Li

BACKGROUND

The Labor and Delivery Unit is characterized by collaboration between multiple teams, high information output, and rapidly evolving changes in patient conditions. A comprehensive handoff, i.e., transition of care, facilitates communication among teams, continuity of care, and patient safety. Accreditation Council for Graduate Medical Education (ACGME) emphasizes the proper training of “Structured and Effective Transition of Care.”1,2

PROCESS OF HANDOFF

When Does the Handoff Occur?

  • Shift changes

  • When provider(s) changes during a surgery

  • When the patient is transferred to the Postanesthesia Care Unit (PACU) or Intensive Care Unit (ICU); Chapter 53, “Postanesthetic Care”

Who Needs a Handoff?

  • Every patient in Labor and Delivery Unit

  • Every patient in PACU

  • Any patients who need follow-up on the postpartum floors or as an outpatient

  • Any antepartum patients who may need potential urgent anesthesia care

  • Any patient admitted to ICU

How to Handoff?

The comprehensive handoff includes “General Information” and “Specific Information” (Table 32-1).

TABLE 32-1Handoff Script for Obstetric Patients
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TABLE 32-1 Handoff Script for Obstetric Patients

General Information

Specific Information

  • Age

  • Gravidity and parity

  • Gestational age

  • Allergies

  • Body Mass Index (BMI)

  • Airway exam

  • Labor epidural including information regarding difficult placement, breakthrough pain management, etc.

  • Labor course, category of fetal heart rate tracing

  • If preeclamptic, details of severe features and related laboratory results

  • If trial of labor after cesarean (TOLAC), indication for prior cesarean

  • If high risk of hemorrhage (H2 and H3), reasons for H2 and H3

  • If thrombocytopenic, the trend of platelet counts

  • If cesarean delivery (CD), intraoperative information and plan for post CD analgesia

  • Other significant medical history

H1, average risk of obstetric hemorrhage; H2, above average risk of bleeding; H3, significant risk of bleeding (Chapter 34, “Evaluation of Hemorrhage Risks”).

REFERENCES

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1. +
VI.E.3. Transitions of care. ACGME program requirements for graduate medical education in anesthesiology 2022. https://www.acgme.org/globalassets/pfassets/programrequirements/040_anesthesiology_2022.pdf. Accessed in December 2022.
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2. +
Agarwala  AV, Lane-Fall  MB, Greilich  PE,  et al. Consensus recommendations for the conduct, training, implementation, and research of perioperative handoffs. Anesth Anal. 2019;128(5):e71–e78.

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