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

Jean Ju Sheen, Laura Reimers, Shravya Govindappagari, Ivan M. Ngai, Diana Garretto, Roopali Donepudi, Pamela Tropper, Dena Goffman, Ashlesha K. Dayal, Peter S. Bernstein

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)437-444
Number of pages8
JournalJournal of patient safety
Issue number6
StatePublished - 2021


  • handoffs
  • patient safety in obstetrics
  • resident education
  • resident work hour restrictions

ASJC Scopus subject areas

  • Leadership and Management
  • Public Health, Environmental and Occupational Health


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