Measuring handoff quality in labor and delivery: development, validation, and application of the Coordination of Handoff Effectiveness Questionnaire (CHEQ)

Jt Comm J Qual Patient Saf. 2013 May;39(5):213-20. doi: 10.1016/s1553-7250(13)39028-x.


Background: A prospective, nonblinded intervention study was conducted (1) to evaluate the psychometric properties of a new questionnaire, the CHEQ (Coordination of Handoff Effectiveness Questionnaire) for measuring the quality of handoff interactions in labor and delivery (L&D) and (2) to demonstrate the utility of the CHEQ in evaluating the effectiveness of a previously described intervention, the tangible handoff, for standardizing handoffs in L&D.

Methods: The CHEQ incorporates three existing handoff-related scales: teamwork climate, job satisfaction, and burnout. Two new scales--information quality and process quality--were developed, refined, and evaluated. The CHEQ was administered to 56 eligible L&D nurses pre- and post-implementation of the tangible handoff intervention.

Results: Baseline and postintervention response rates for the CHEQ were 98% and 84%, respectively. Overall, the teamwork climate scale significantly improved from 57.17% to 68.35% (t = -2.84, p = .006), and the burnout scale significantly decreased from 49.70% to 36.21% (t = -2.56, p = .012) following implementation of the tangible handoff. Job satisfaction improved, although not at a statistically significant level. Cronbach's alpha results ranged from .68 to .96 for all scales, both pre- and post-intervention.

Conclusions: The CHEQ is psychometrically sound for evaluating handoffquality, is practical to administer, achieves high response rates, and is amenable to straightforward statistical analysis. The CHEQ is useful for evaluating handoff quality and gauging the responsiveness to a unit-level intervention in the scope of unit-level climate. The CHEQ may be replicated or adapted for other clinical areas to investigate handoffs and inform the design and evaluation of handoff interventions.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Burnout, Professional*
  • Continuity of Patient Care / standards*
  • Delivery, Obstetric / nursing*
  • Female
  • Health Services Research
  • Humans
  • Job Satisfaction*
  • Labor, Obstetric*
  • New Jersey
  • Patient Care Team / organization & administration*
  • Patient Handoff / standards*
  • Pregnancy
  • Prospective Studies
  • Psychometrics
  • Quality Assurance, Health Care
  • Reproducibility of Results
  • Surveys and Questionnaires*