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Systematic review and meta-analysis of interventions for operating room to intensive care unit handoffs
  1. Joanna Abraham1,
  2. Alicia Meng1,
  3. Sanjna Tripathy2,
  4. Michael S Avidan1,
  5. Thomas Kannampallil1
  1. 1Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
  2. 2Washington University in St Louis, St Louis, Missouri, USA
  1. Correspondence to Dr Joanna Abraham, Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, MO 63110, USA; joannaa{at}


Objective To conduct a systematic review and meta-analysis to ascertain the impact of operating room (OR) to intensive care unit (ICU) handoff interventions on process-based and clinical outcomes.

Method We included all English language, prospective evaluation studies of OR to ICU handoff interventions published as original research articles in peer-reviewed journals. The search was conducted on 11 November 2019 on MEDLINE, CINAHL, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials databases, with no prespecified criteria for the type of comparison or outcome. A meta-analysis of similar outcomes was conducted using a random effects model. Quality was assessed using a modified Downs and Black (D&B) checklist.

Results 32 studies were included for review. 31 studies were conducted at a single site and 28 studies used an observational study design with a control. Most studies (n=28) evaluated bundled interventions which comprised information transfer/communication checklists and protocols. Meta-analysis showed that the handoff intervention group had statistically significant improvements in time to analgesia dosing (mean difference (MD)=−42.51 min, 95% CI −60.39 to −24.64), fewer information omissions (MD=−2.22, 95% CI −3.68 to –0.77), fewer technical errors (MD=−2.38, 95% CI −4.10 to –0.66) and greater information sharing scores (MD=30.03%, 95% CI 19.67% to 40.40%). Only 15 of the 32 studies scored above 9 points on the modified D&B checklist, indicating a lack of high-quality studies.

Discussion Bundled interventions were commonly used to support OR to ICU handoff standardisation. Although the meta-analysis showed significant improvements for a number of clinical and process outcomes, the statistical and clinical heterogeneity must be accounted for when interpreting these findings. Implications for OR to ICU handoff practice and future research are discussed.

  • surgery
  • critical care
  • hand-off
  • transitions in care
  • checklists

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  • Contributors JA, MSA and TK conceived the study. JA, AM and ST were involved in conducting the search, data extraction and organisation. JA and TK conducted the meta-analysis. All authors were involved in the writing of the manuscript, critically revising it for publication.

  • Funding This study was funded by Washington University/BJC HealthCare (Big Ideas Program).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing is not applicable as no data sets were generated and/or analysed for this study. This is a systematic review. No data are available for sharing.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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