Patient handoffs in surgery: Successes, failures and room for improvement

Table 1 Selected surgical handoff studies

Ref.	Design	Methods	Results
Johner et al[18]	Multi-center survey	Handoff practices of acute care surgery service in six Canadian general surgery residency programs	39 of 52 surveyed responded. 60% handoffs were mostly are always conducted face to face. Vast majority involved some kind of verbal communication
Zavalkoff et al[25]	Single-center implementation of handoff tool	Assess if implementing fill-in-the-blank handoff tool for pediatric heart surgery patients going to intensive care unit improved communication and adverse events	31 handoffs analyzed compared to handoffs prior to sheet. Following implementation of the tool, increase in detail of useful information transfer, no significant increase in time for handoff, lower rate of adverse events but did not reach significance
Scoglietti et al[12]	Single-center analysis of sign-out sheets	Resident sign-out sheets, which stratified problematic vs non-problematic patients, were collected over a 3-mo period. Patient outcome was analyzed	More non-problematic patients had adverse events, only 42% of adverse events occurred in the problematic patients
Al-Benna et al[19]	Multi-center telephone questionnaire	Handoff practices and quality by queried trainee surgeons at 30 British Isles burns units	Majority of units had junior-to-junior handoffs (76.7%), senior-to-senior trainee handoff (56.7%), and more than one level of trainee present. Few handoffs sessions were pager-free of interruptions (10%) and few had formal handoff training (16.7%)
Gawande et al[11]	Multi-center interviews	Interview of 38 surgeons from three academic teaching hospitals to identify errors that led to patient incidents	145 incidents reported, 43% (n = 62) of which were due to communication breakdown; of these 66% (n = 41) were due to handoffs errors