SHARED maternity care: enhancing clinical communication in a private maternity hospital setting

Sara J Hatten-Masterson and Marnie L Griffiths
Med J Aust 2009; 190 (11): S150. || doi: 10.5694/j.1326-5377.2009.tb02624.x
Published online: 1 June 2009

Midwives and visiting medical officers (VMOs) in private practice have a unique relationship within the private hospital setting. The effective exchange of accurate information between them is a fundamental element of patient safety and is vital to the success of the clinical handover process.1-5 The midwife is reliant on information provided by the VMO, as a woman’s recent history and current condition will not always be available in the medical record. Throughout labour, birthing and the postnatal period, the VMO may be reliant on information gathered and communicated by the midwives providing care. This exchange of information sometimes occurs face-to-face, but more commonly occurs via telephone, as VMOs may work in multiple locations.

Thus, the effective transfer of accurate and appropriate patient information is a fundamental element of patient safety and quality care. The accuracy, timeliness and relevance of this information and the style of handover used is vital to the success of the handover process. The SHARED (situation, history, assessment, risk, expectation and documentation) project6 (see below) sought to develop, implement and evaluate a framework and support tools for improving clinical handover in two private maternity hospitals in Brisbane, the Mater Mothers’ Private Hospital (MMPH) and the Mater Private Hospital Redland (MPHR). The MMPH is a tertiary referral hospital birthing about 4500 babies a year. The MPHR is a small (60-bed) hospital that births about 450 babies per year. These hospitals offered an excellent context in which to develop and test a framework for clinical handover to enhance the safety and quality of maternity care.


The project included a pre- and post-study design using clinician surveys, chart audits, patient satisfaction surveys and a review of clinical incident data to measure change in satisfaction, attitudes and practice with handover and documentation.

After the implementation of the SHARED framework, a clinician satisfaction survey showed that most respondents were aware of the SHARED framework and its support tools and found them helpful.

The chart audit demonstrated an improvement (from 13% to 24%) in “adequate overall” documentation after implementation of the SHARED framework, with statistically significant improvements occurring in three of the ten criteria measured (legibility of documentation, time entered, and signature used).

At MPHR, there was no statistically significant change in patient satisfaction with regard to questions on the following issues:

At MMPH, patient satisfaction around “how staff worked together to care for you” improved by 6.9 mean score points and saw this question move from 10th to 19th most important on the priority index of areas for improvement.

It was noted that, throughout the implementation of the SHARED framework, there was an overall reduction in reported clinical incidents in which communication failure was identified as a contributory factor. However, it is well documented that the use of clinical incident data is not a reliable measure, as its accuracy is variable.9

  • Sara J Hatten-Masterson1
  • Marnie L Griffiths2

  • Clinical Safety and Quality Unit, Mater Health Services, Brisbane, QLD.

Competing interests:

None identified.


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