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Consensus recommendations for the conduct, training, implementation, and research of perioperative handoffs

Anesthesia and Analgesia May 1, 2019

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Research Areas

PAIR Center Research Team


Health care–related transitions of care (ie, handoffs or handovers) are often associated with patient harm. Care transitions have been identified as a high-priority safety concern by providers in several safety climate surveys and are an area of focus of health care regulatory agencies. Poor communication at the time of handoff has been implicated in adverse outcomes including diagnostic testing errors, delays in diagnosis and treatment, increase in patient harm, higher hospital readmission rates and costs, and an increase in malpractice claims. One study estimated that up to 80% of serious medical errors involve communication failures between care providers during the transfer of patients.

Although most of the evidence on handoffs is not focused on perioperative care, handoffs during perioperative care are equally prone to failures. Yet, there are few studies and little credible evidence identifying the key sources of risk and best practices for improved performance. An association between the occurrence of intraoperative handoffs and increased adverse events and morbidity and mortality has been demonstrated as has improvement in intraoperative information transfer with standardization. However, evidence that intraoperative handoff interventions have an impact on outcomes is lacking.

Given the paucity of evidence regarding handoffs in perioperative care, the Anesthesia Patient Safety Foundation convened a group of experts to establish consensus on several key aspects regarding perioperative handoffs and their safety implications, with the intent to suggest best practices and areas for further investigation. The development of consensus guidelines by experts within a field can be helpful when there is a lack of high-quality evidence. Our objective was to identify areas of consensus on 6 areas related to perioperative handoffs: (1) process elements and behaviors; (2) metrics and measurement; (3) important research questions; (4) best ways to manage training and education; (5) how best to implement; and (6) how to incorporate patient and family goals into handoffs. The meeting used a robust process used to achieve consensus. We report briefly on that process and focus on the results, which are intended to guide implementation and improvement of perioperative handoff processes and research.