Postoperative handover: characteristics and considerations on improvement A systematic review

CONTEXT Current research has identified numerous safety risks related to patient handovers including postoperative handovers. During the postoperative handover and the recovery period, the patient is at risk of potential complications of surgery or anaesthesia. Furthermore, patients are subject to a downscale in monitoring and observation, which makes them vulnerable to incidents and errors. OBJECTIVES To describe the characteristics and potential hazards to quality and patient safety during postoperative handover. To identify concrete recommendations for improvement in this process. DESIGN A systematic review of the literature. DATA SOURCES Comprehensive search of electronic data-bases (Medline, Embase, Cochrane Library) in March 2012. Additional studies were obtained from bibliographies of retrieved reports. ELIGIBILITY CRITERIA Studies analysing the characteristics of the postoperative handover and interventional studies with the aim of improving postoperative handover. Only original research was included. RESULTS We identified 23 studies including descriptive and interventional studies. Postoperative handovers are described as a complex work process challenged by interruptions, time pressure and a lack of supporting framework. Interventional studies introduced standardised handover tools in combination with environmental changes, resulting in better flow of information in four out of five, better teamwork in two and less technical errors in two out of three studies. CONCLUSION Postoperative handover is a complex and dynamic situation. It is very important to analyse the challenges in the local setting and that solutions are customised to fit the specific context in which the postoperative handovers takes place. It is also important to acknowledge the role of non-technical skills in the work process with respect to patient safety. Implementation of new handover strategies must be considered carefully. To optimise the motivation for change among staff, the importance of improvement in postoperative handover in all settings must be outlined in future studies with more patient-specific outcomes. Published online 13 March 2013