The Hidden Costs of Clinician Burnout: How Handoff Failures Drive Overtime and Near Misses

Every shift change in a Labor & Delivery unit is a high-stakes moment. Whether it's a nurse handing off to the next shift, an OB-GYN signing out to a colleague, or a midwife transferring care—the 15-20 minutes it takes to communicate about multiple laboring patients is fraught with risk. Critical information can be lost, overlooked, or miscommunicated. The consequences ripple outward: missed allergies, delayed interventions, near misses, and in the worst cases, preventable adverse events.

But the impact doesn't stop at patient safety. Incomplete handoffs force clinicians to spend extra time hunting down missing information, clarifying orders, and double-checking details that should have been communicated clearly. This documentation burden—combined with the emotional toll of caring for high-acuity patients—is driving an unprecedented crisis of burnout and turnover across L&D teams.

The Documentation Burden Problem

No clinician entered their profession to spend hours charting. Yet studies consistently show that L&D nurses spend 25-35% of their shift on documentation, while physicians average over 2 hours daily on EHR tasks—time that could be spent providing direct patient care.

The problem is especially acute during handoffs. Traditional handoff processes require clinicians to:

• Manually compile patient summaries from multiple EHR screens
• Transcribe vital signs, labs, and medication lists
• Summarize hours of labor progress into a verbal report
• Document their own assessments while listening to report
• Chase down missing information from previous shifts or providers

This cognitive load isn't just exhausting—it's error-prone. When clinicians are overwhelmed with documentation tasks, critical details slip through the cracks.

When Handoffs Fail: The Near Miss Problem

The Joint Commission has identified communication failures during handoffs as a leading cause of sentinel events in hospitals. In obstetrics specifically, incomplete handoffs between nurses, physicians, and midwives have been linked to:

Research from the Agency for Healthcare Research and Quality (AHRQ) found that structured handoff protocols can reduce preventable adverse events by up to 30%. Yet many L&D units still rely on informal, unstructured verbal reports that vary wildly from clinician to clinician.

The Overtime Cost Spiral

When handoffs are incomplete, someone has to fill in the gaps. For nurses, it means staying late. For physicians and midwives, it means spending precious minutes re-reviewing charts instead of seeing patients. The result is a cascade of inefficiency that hospitals are struggling to control.

"I routinely stay 30-45 minutes past my shift just to track down information that should have been in the handoff report. Labs that were pending, medications that were due, conversations with the attending that weren't documented. It adds up."
— L&D Charge Nurse, Mountainside Medical Center

"When I come on for night call, I often spend the first 20 minutes re-reviewing charts because the sign-out was incomplete. That's time I could be rounding or responding to a delivery."
— OB-GYN Hospitalist, Hackensack Meridian Medical Center

For a typical 30-bed L&D unit, incomplete handoffs translate to:

• 3,300+ hours of nursing overtime annually
• $165,000+ in additional labor costs (at 1.5x overtime rates)
• Accelerated burnout as clinicians consistently work beyond their scheduled shifts
• Increased turnover as exhausted staff leave for less demanding settings

Turnover itself is extraordinarily expensive. The NSI Nursing Solutions 2025 report found that the average cost to replace a bedside RN is now $52,350. Physician recruitment costs are even higher—often exceeding $500,000 when accounting for lost revenue during vacancies. A unit with 20% annual nursing turnover is spending over $1 million just to maintain staffing levels.

Burnout Across All Roles

Handoff failures don't discriminate by credential. Every member of the L&D care team suffers when communication breaks down:

Nurses

L&D nurses bear the brunt of documentation burden, spending 25-35% of their shift on charting. When handoffs are incomplete, they stay late, hunt down missing information, and absorb the stress of caring for patients without complete context. It's no wonder 62% report burnout symptoms.

Physicians

OB-GYNs spend an average of 2 hours per day on documentation—time that contributes to the specialty's 53% burnout rate. When sign-outs are incomplete, physicians must re-review entire charts, make clarifying phone calls, and repeat conversations with patients about plans that were already discussed.

Midwives

Certified Nurse Midwives often practice in collaborative models where seamless handoffs with physicians are essential. When a midwife transfers care to an OB for a high-risk situation, incomplete communication can delay critical interventions. The emotional toll of these near-misses compounds the already demanding nature of midwifery.

This inefficiency doesn't just waste time—it increases cognitive load and contributes to the decision fatigue that leads to errors.

SBAR and the Limits of Standardization

Many hospitals have implemented SBAR (Situation, Background, Assessment, Recommendation) protocols to standardize handoff communication. While SBAR is a valuable framework, it has limitations in high-acuity obstetric settings:

• Manual compilation: Clinicians must still manually gather and organize information into SBAR format
• Inconsistent adherence: Under time pressure, nurses and providers often skip or abbreviate sections
• No real-time updates: Paper or verbal SBAR reports become outdated as patient status changes
• Missing context: Critical details like PPH risk scores or intervention timelines may not fit neatly into SBAR categories
• Role-specific gaps: What a nurse needs to know differs from what a physician or midwife needs—one format doesn't fit all

The solution isn't to abandon SBAR—it's to automate it. When handoff reports are generated automatically from real-time patient data, clinicians can focus on clinical nuances rather than data compilation.

How Automated Handoffs Change Everything

Birth Model's Smart Handoffs feature was designed specifically to address these challenges. By automatically compiling patient data into structured nursing and clinician handoff reports, we eliminate the documentation burden while ensuring nothing falls through the cracks.

For Nursing Handoffs

Our nursing handoff reports automatically include:

• Current vitals with abnormal values highlighted
• Complete medication list with last administration times
• Lab results with pending orders flagged
• Cervical exam progression with estimated delivery time
• Risk scores (PPH, preeclampsia) with contributing factors
• Allergies prominently displayed with cross-reactivity warnings
• Active care plans and pending orders

For Physician and Midwife Handoffs

Our AI-generated SBAR reports provide:

• Concise situation summary with acuity level
• Complete background including relevant OB history
• Current assessment with all active problems
• Clear recommendations with "Don't Miss" safety alerts
• Pending decisions and anticipated interventions
• Key conversations with patients and families

The ROI of Better Handoffs

Hospitals implementing automated handoff solutions have reported:

• 15-20 minutes saved per clinician per shift on handoff preparation
• 40% reduction in handoff-related safety events
• 25% decrease in end-of-shift overtime
• Improved satisfaction scores across nurses, physicians, and midwives
• Reduced turnover as clinicians experience less daily frustration

For a 30-bed L&D unit, these improvements can translate to $200,000+ in annual savings from reduced overtime and turnover alone—not counting the incalculable value of prevented adverse events.

Moving Forward

The clinician burnout crisis in L&D won't be solved with pizza parties or resilience training. It requires fundamentally rethinking the systems and workflows that drain everyone's time and energy—nurses, physicians, and midwives alike.

Handoffs are a critical intervention point. By automating the compilation of patient data and ensuring consistent, complete communication at every shift change and provider transition, we can give clinicians back time for what they do best: caring for mothers and babies during one of the most important moments of their lives.

The technology exists. The ROI is clear. The only question is how long we'll continue to accept a status quo that burns out our care teams and puts patients at risk.

For more information on how Birth Model's Smart Handoffs can reduce documentation burden for your entire L&D team, schedule a demo or visit our clinician solutions page.