Elsevier

Surgery

Volume 158, Issue 1, July 2015, Pages 85-95
Surgery

Health Care
Effectiveness of interventions to improve patient handover in surgery: A systematic review

https://doi.org/10.1016/j.surg.2015.02.017Get rights and content

Background

Handover of patient care is a critical process in the transfer of information between clinical teams and clinicians during transitions in patient care. The handover process may take many forms and is often unstructured and unstandardized, potentially resulting in error and the potential for patient harm. The Joint Commission has implicated such errors in up to 80% of sentinel events and has published guidelines (using an acronym termed SHARE) for the development of intervention tools for handover. This study aims to review interventions to improve handovers in surgery and to assess compliance of described methodologies with the guidelines of the Joint Commission for design and implementation of handover improvement tools.

Methods

A systematic review was conducted in line with MOOSE guidelines. Electronic databases Medline, EMBASE, and PsyInfo were searched and interventions to improve surgical handover identified. Intervention types, development methods, and outcomes were compared between studies and assessed against SHARE criteria.

Results

Nineteen studies were included. These studies included paper and computerized checklists, proformas, and/or standardized operating protocols for handover. All reported some degree of improvement in handover. Description of development methods, staff training, and follow-up outcome data was poor. Only a single study was able to demonstrate compliance with all 5 domains guidelines of the of Joint Commission.

Conclusion

Improvements in information transfer may be achieved through checklist- or proforma-based interventions in surgical handover. Although initial data appear promising, future research must be backed by robust study design, relevant outcomes, and clinical implementation strategies to identify the most effective means to improve information transfer and optimize patient outcomes.

Section snippets

Search strategy

A systematic review was conducted in line with Meta-analysis Of Observational Studies in Epidemiology (ie, MOOSE) guidelines for the reporting of systematic reviews of observational studies.17 Using the OvidSP search platform, we searched the Medline, EMBASE, and PsycInfo databases from database inception up to the end of December 2013. The search strategy combined “surgery” AND the terms “information transfer”, OR “information flow” OR “hand over” OR “handover” OR “hand off” OR “handoff” OR

Results

The initial search returned 970 results, 20 of which were retrieved in full-text form for further consideration. After application of the inclusion criteria as described, and the addition of 3 publications retrieved through a hand search of references, a total of 19 studies were included in the final data synthesis (see Fig).12, 13, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38

Discussion

This review is the first to assess the currently published body of evidence for interventions designed to improve the process of surgical handover. The growing recognition of handovers as a key area for process improvement spurred on in part by the Joint Commission SHARE guidelines is reflected in the fact that almost three quarters (14/19, 74%) of peer-reviewed publications on this topic have been published in the past 5 years alone.

The results of this systematic review suggest that checklist-

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    Drs Johnston, Arora, and Darzi are associated with the National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. Rajesh Aggarwal is a consultant for Applied Medical. All other authors declare no conflicts of interest or other sources of funding for this work.

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