spiral.imperial.ac.uk€¦ · Web viewEffectiveness of interventions to improve patient handover in surgery: A systematic review. Philip H Pucher, MD, MRCS1, Maximilian J Johnston,

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

Philip H Pucher, MD, MRCS1, Maximilian J Johnston, MB BCh, MRCS1,2, Rajesh Aggarwal,

MBBS, MA, PhD, FRCS3,4, Sonal Arora, MD, MRCS, PhD1,2, Ara Darzi, MD, FRCS, FACS1,2

1Division of Surgery, Department of Surgery and Cancer, Imperial College London, London,

UK

2Centre for Patient Safety and Service Quality, Imperial College London, London, UK

3Department of Surgery, Faculty of Medicine, McGill University, Montreal, Canada

4Arnold & Blema Steinberg Centre for Medical Simulation, McGill University, Montreal,

Canada

Correspondence to: Philip PucherDepartment of Surgery and Cancer10th floor QEQM Building, St Mary’s HospitalPraed StreetLondon W2 1NY

United Kingdom

Tel: +44 20 3312 6666

Fax: +44 20 3312 6309

Email: [email protected]

Header: Handover interventions in surgery

Keywords: Handover; handoff; signoff; communication; surgery

Word count: 2622

Conflict declaration: No funding was received by the authors relating to the completion of this work. 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

1

mailto:[email protected]

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.

All authors have reviewed and approved the final version of the manuscript.

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Abstract

Background: Surgical handover is a critical process in the transfer of information between

clinical teams and clinicians during transitions in patient care. It may take many forms and is

often unstructured and unstandardized, potentially resulting in error and patient harm. The

Joint Commission has implicated such errors in up to 80% of sentinel events and has

published SHARE guidelines for the development of handover intervention tools. This study

aims to review interventions to improve handover in surgery, and assess compliance of

described methodologies with Joint Commission guidelines 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 included paper and computerised

checklists / proformas, and/or standardised operating protocols for handover. All reported

some degree of handover improvement. Description of development methods, staff training,

and follow-up outcome data was poor. Only a single study was able to demonstrate

compliance with all five domains of Joint Commission guidelines.

Conclusions: Improvements in information transfer may be achieved through checklist- or

proforma-based interventions in surgical handover. While initial data appears 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.

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Introduction

Transition points in the surgical patient pathway present significant risks to patient safety.1

Failures in information transfer during transitions between places of care (e.g. the operating

room, intensive care unit, or surgical ward) occur during the handover of patient-related

information between responsible members of staff, or during changes in staff (shift change),

and may lead to errors and preventable patient harm.1 Multiple domains may have an effect

on the quality of handover, including the context (e.g. shift / daily handover, handover from

theatre to recovery, or patient discharge), setting (face-to-face vs. remote) and staff

(interprofessional vs. single-discipline) involved in the process.

The improvement of handover takes on particular importance in surgery due to the

additional transfers unique to the surgical patient pathway. In addition to the standard

handovers resulting from staff changeover, patients are subject to pre-operative, intra-

operative, and post-operative transfers. Furthermore, in the event of clinical deterioration,

patients may be subject to particularly critical handovers during the escalation of care.2

Clinical handoff or handover may be defined as the transfer of professional responsibility

and accountability for a patient’s care to another professional.3 Appropriate and effective

communication is a crucial component of handover to ensure effective continuity of care,4, 5

with failures associated with errors, adverse events,6 and avoidable patient harm.7 In recent

years, the introduction of the European Working Time Directive in the UK, and the Resident

Duty Hours limits in the USA, have had a detrimental effect on continuity of care for

patients.8, 9 The resulting increased number of shift handovers taking place, and the

associated complexity of the handover process may have a role to play in this.

Data published by the Joint Commission has consistently highlighted communication error as

the most common root cause of sentinel events.10 Handover errors, in particular, have been

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implicated in as many as 80% of all events.4 To address this issue, the Joint Commission

recently developed the Targeted Solutions Tool for Hand-off Communications. Developed in

collaboration with 10 leading US hospitals, the tool describes specific guidelines for

handover or information transfer-related process improvement projects aiming to avoid

delays in treatment and patient harm. These SHARE guidelines were developed based on the

analysis of specific root causes within the handover process, and stipulate that a well-

conducted handover process must include the following:

Standardisation of critical content (patient details involved in information transfer)

Hardwiring within the hospital system through use of standardized tools and

methods (e.g. checklists)

Allow opportunities to ask questions

Reinforce quality and measurement through incorporation into clinical governance

and on-going audit

Educate and coach in the conduct of successful handovers

The recommended SHARE framework reflects the growing acceptance of the fact that

despite their potential effectiveness,11 the introduction of proformas or checklists to

improve care is not enough. A number of interventions aiming to improve handover

processes in surgery have been developed and evaluated. Resulting publications variably

report improved information transfer, more effective teamwork and fewer errors.12-14

However, the interventions described do not align well with the SHARE guidelines and omit

any exploration of the impact on patient outcomes.

Without effective strategies of implementation, reinforcement, and education, such

protocols risk becoming an ineffective “box-ticking” exercise,15 or engendering resistance

within an organisation to become a negative, rather than positive, change.16 As such,

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adherence to SHARE guidelines is likely to play a critical role in the success of any

interventions to improve handover. Furthermore, the publication of such guidelines

encourages groups pursuing such interventions and related research to do so to the highest

clinical and academic standard.

This review aims to review best evidence regarding handover interventions in surgery, and

evaluate their design and implementation against the SHARE guidelines.

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Methods

Search strategy

A systematic review was conducted in line with MOOSE guidelines for the reporting of

systematic reviews of observational studies.17

Using the OvidSP search platform, the Medline, EMBASE, and PsycInfo databases were

searched 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 “sign out” OR “sign out” OR “sign off”

OR “signoff” OR “communication tool” OR “SBAR” (incorporating Boolean operands “AND”

and “OR” as shown).

Screening of titles and abstracts identified articles of potential interest, which were then

retrieved for independent full-text analysis and data extraction. In addition, reference lists of

retrieved articles were hand-searched for additional relevant references.

Selection criteria

Studies considered for inclusion were those which reported the effects of an intervention

designed to improve handover in a surgical patient population, comparing outcomes

between pre- and post-intervention, or control and intervention, groups. No limitations

were placed on study endpoints or outcome types. Two independent researchers

conducted the search, with differences resolved via consensus and consultation with the

research team.

Assessment of methodological quality

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The intervention described in each study was compared to the Joint Commission’s SHARE

domains. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) for cohort

studies,18 which assigns a score of 0-9 with points assigned on the basis of a sample’s

representativeness of the exposed cohort, comparability of cohorts, controlling for

confounding factors, and appropriateness of outcome selection and reporting. Previous

studies have suggested a score of 7 or greater to represent studies of acceptable quality.19, 20

Randomized trials were evaluated using the Jadad score,21 assigning a quality score from 1-5

(a score of 3 or higher being considered acceptable), with points assigned depending on the

appropriateness of randomisation, blinding, and description of any dropouts or exclusions.

Results

The initial search returned 970 results, 20 of which were retrieved in full-text form for

further consideration. Following application of the inclusion criteria as described, and the

addition of three publications retrieved through a hand search of references, a total of 19

studies were included in the final data synthesis (see Figure 1). 12, 13, 22-38

Study demographics

A single randomized cross-over trial by Van Eaton and colleagues, describing the effects of

the implementation of a computerized patient handover data system, was included – the

authors reported results of the same trial and dataset in two separate publications,37, 38

which were combined for the purposes of results reporting (see Table 1). The remaining 17

studies comprised pre-/post-intervention cohort studies.

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Seven studies assessed postoperative handovers in paediatric cardiac surgical patients. 22, 23,

25, 29, 32, 34, 36 One further study considered the same setting in adult patients.26 The remaining

studies assessed ward-based surgical handovers.

Interventions to improve handover

The primary outcome for all but four studies was accuracy of information transfer, measured

either by the number of handover errors, or adherence to a handover checklist. All studies

reported significant improvements in practice in the post-intervention cohorts.

Interventions to improve surgical handover (See Table 2) fell into two broad categories: (1)

standardized handover proformas (incorporating either information transfer checklists, or

written or computer-based proformas), and/or (2) formalization of standardized handover

procedures. Of those studies incorporating a handover proforma, only five studies included

integration with electronic medical records,24, 27, 28, 30, 38 with the rest using paper-based

checklists or non-integrated computer systems (e.g. computerised spreadsheet to be

updated separately).

Proformas and checklists

The use of “prompt” tools – proformas or checklists – was by far the most commonly cited

intervention, used in 16/19 (84%) of included studies. Though the precise nature of their

development and implementation varied, all studies reported positive improvements in the

handover process, with improved completeness of handover or reduced error rate.

Perhaps representing one of the best integrated systems, Wohlauer and colleagues27

described the implementation of a computerized tool, based on the University of

Washington’s computerized system (UoW CORE) – as described in the publications by Van

Eaton et al.37, 39 – to improve information transfer and handover, assessing the time required

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for pre-rounding and the frequency of patients missed on the ward round. Outcomes were

self-reported by residents, with the new handover system resulting in a reduction of pre-

rounding time (62.7 vs. 51.9 min, p = 0.0064), and frequency of missed patients (p = 0.0037).

Van Eaton et al. also assessed the rates of missed patients and times spent pre-rounding in

their description of the original UoW CORE system, reporting similar reductions.37, 38

Only a single study reported any patient outcomes, with Ryan and colleagues30 assessing

differences in length of stay before and after the implementation of a computerized

template for handover information, and reporting a reduction in length of stay from 5 to 4

days (p = 0.047) in a general and vascular surgical population.

Standardization of handover procedures

Three studies assessed the impact of changes to standardized operating procedures through

formalization of previously variable handover processes without the use of checklists or

proformas.29-31

Mistry and colleagues34 adapted a performance improvement framework (using Six Sigma

methodology) from the manufacturing industry to standardize handover procedures,

introducing this to staff through practice sessions, as well as having staff complete a team

training curriculum (Team STEPPS).40 They found this resulted in reduced handover time

(15.3 vs. 9.6 minutes, p<0.001) and time required to access lab study results. Catchpole et

al.’s30 “pit-stop” model derived from motorsport resulted in a significant decrease in

handover omissions (5.42 ± 1.24 vs. 3.15 ± 0.71). Conversely, the third study, by Petrovic et

al., reported an only marginal decrease in omissions (19% vs. 17%), though self-reported

satisfaction scores increased (61% vs. 81%).

Three other studies combined changes to handover standard operating procedures with the

introduction of checklists as the central component of the new process.25-27

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Development and implementation

Six studies utilized methods based on peer-reviewed or expert group guidelines,12, 13, 28-30, 32

three adapted handover algorithms or strategies utilized in other industries such as

motorsport or aviation.33, 34, 36 The interventions described in the remaining studies were

developed de novo, based upon local consultation of staff.

The majority of studies (11/18) described initial training for staff prior to implementation of

the intervention; however this was limited to didactic or informal sessions in most (7/11).

Four studies described pilot or simulation-based sessions as part of staff training.

Quality assessment of studies

The quality of included studies was poor. Study quality, as measured by the Newcastle-

Ottawa Score, ranged from 3-6, with a single study achieving a score of 8. Studies suffered

from a lack of description of the assessed staff and patient cohorts. Most studies failed to

report the demographic details of the study participants, or compare between pre- and

post-intervention cohorts. All cohort studies used a pre-/post-intervention study design,

with many collecting data through direct observation, introducing a risk of observer-

expectancy bias (“Hawthorne effect”). The randomized trial described by Van Eaton scored

2 points on the Jadad scale, lacking blinding, description of group demographics, or

dropouts.

None of the included studies used adjusted statistical models in their reporting of outcomes.

Adherence to SHARE domains

Adherence of the implementations in the included studies to the five SHARE domains

described by the Joint Commission was variable.

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90% (17/19) Standardized the information contained in handovers. The studies by Mistry et

al.34 and Catchpole et al.36 both sought to standardize handover procedures in paediatric

cardiac surgery, but the unlike other studies in this context included in this review, did not

specify the information to be included in handover itself.

Hardwiring into the system of checklists or proformas, by adding them as computerized or

paper forms to standard medical documentation, was described by 79% (15/19) studies.

Allowed opportunities for questions were present in 69% (13/19). The reinforcement of

quality, either through direct feedback or longitudinal assessment, was present in only a

single study (5%). Clark et al.28 reported results both immediately after and at 3 months

following the implementation of their computerized handover tool, with good retention of

handover quality, this was also the only study to comply fully with all five domains of the

SHARE guidelines. Finally, Education was described as a component of 53% (10/19) studies.

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Discussion

This review is the first to assess the currently published body of evidence for interventions to

improve the surgical handover process. The growing recognition of handovers as a key area

of 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- or proforma-based interventions

may be effective in improving the quality and completeness of surgical handover. Noted

patient safety expert James Reason has previously commented on the effectiveness of such

“prompts” to reduced omission error.41 However, the interpretation of these findings is

tempered by a profound lack of methodological quality in current published evidence, with

the majority of studies conducting audit-style assessments of performance, lacking blinding

of assessors, randomisation of subjects, or adjustment of results for confounding variables.

As a result, the risk of bias in the studies reviewed here must be viewed as high, a fact

further reflected by low Newcastle-Ottawa and Jadad quality assessment scores.

The majority of studies sought to standardize the handover process through checklists or

proformas to improve and standardize communication – in line with the first three SHARE

domains, Standardisation, Hardwiring, and Allowing questions. Checklists and checklist-

based interventions have experienced an explosion of interest in the surgical community in

the past decade, with reductions in morbidity and mortality widely attributed to their use.42,

43 However, the results of this review suggest that compliance with SHARE guidelines, as a

whole, is poor, with only a single included study addressing all five domains.28 Though most

studies sought to Standardise the handover process in an open manner (Allowing questions),

the Hardwiring of interventions was in most cases limited to the addition of further

paperwork in the form of a paper checklist is form to be filled in. Ideally, such procedures

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should be integrated directly with electronic medical records – thereby reducing risk of

transcription errors through autopopulation of handover information from the patient

record, as well as the work required to complete the checklist, encouraging its use.

Amongst the interventions included, the lowest compliance was seen with the two domains

– Reinforcement and Education – which are most critical to their successful implementation

and maintained use. Just as handover interventions seek to build on the successes of

checklists, so too must they be wary of their limitations. Recent evidence continues to place

increasing emphasis on the importance of staff education, non-technical skills training, and

implementation process.16 Urbach and colleagues reported outcomes following the

introduction of the World Health Organisation’s widely adopted Surgical Safety checklist

across 101 hospitals and over 200,000 patient episodes in Ontario, Canada.15 Despite

reported compliance rates of almost 100%, they reported no significant differences in

adjusted rates of morbidity or mortality before and after checklist implementation, which

authors suggested might be due to a lack of standardized implementation strategies. In

addition, the mandating of interventions without thoroughly demonstrating the need for

change (staff education) has been shown to cause failure further down the line.44

To maximize the possibility of successful implementation of any such intervention, staff must

be first given the opportunity to train in their use. Staff must be made to feel accountable

for continued use of the intervention if it is to succeed.45 Training staff in the use of an

intervention may include simulation-based sessions46 or team training.47 Though a minority

of studies included in this review included such strategies, most relied on simple didactic

sessions, or lacked educational components altogether. With the growing use of ward-

based simulation,48, 49 the use of handover-checklists within high-fidelity environments is

both feasible and desirable. Once implemented, continued Reinforcement and quality

measurement should be pursued to ensure quality is maintained.

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The findings of this systematic review are limited by the quality of the available evidence. As

discussed, low overall study quality has precluded a formal meta-analysis and limits the

generalizability of study results. The lack of clinical outcomes is a further limitation,

precluding assessment of both the clinical efficacy of the varied interventions, as well as

their validity. Without clinical outcomes or an evidence-based development process, the

validity of the majority of interventions included in this review cannot be assured; though

the amount of information transferred in each study was improved, a lack of clinical

correlation means that it is impossible to know whether the included information would

have in fact affected clinical outcomes. However, in performing a thorough and systematic

search, this review’s strengths are to provide a full overview of the current state of evidence,

describe methodological gaps, and thereby recommend potential directions for future

research and care improvement efforts.

The “gold standard” used in this review, the Joint Commission’s SHARE guidelines, might

itself be considered a potential point for criticism, it should be noted. Though SHARE was

chosen as it represents the only clear guidance from a national organisation on the topic, it

was developed through an expert consultation process, rather than based upon outcomes

evidence. Indeed, the limited data presented in this review is neither able to convincingly

support, not refute, any association between adherence to SHARE and interventional

effectiveness. Clark et al.’s28 methods were fully (5/5) compliant and resulted in a reduction

of handover errors, whereas Van Eaton et al.23 similarly reported fewer missed patients and

improved rounding efficiency despite poor compliance (2/5). This lack of evidence-based

guidelines for handover processes (including SHARE), however, should be considered as a

symptom of the rapid and only recent development of interest in this area, and as an

opportunity for such guidelines to be developed, rather than a limitation.

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Conclusions

In conclusion, this study presents a review of current interventions designed to improve

handover in surgery. Though the included studies unanimously report improved information

transfer, methodological quality is poor and to date meaningful assessment of clinical

outcomes are lacking. Compliance with the Joint Commission’s SHARE guidelines, intended

to ensure successful implementation of handover improvement strategies, is highly variable,

despite existing evidence for surgical checklists highlighting the importance of strategies for

reinforcement and education measures.

The use of checklists to improve surgical handover appears promising, but 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.

Initially it may be appropriate to focus on successful information transfer (as many of the

studies described here do). However, as handover processes mature, the goal in future

must be to also identify which elements of information transfer are most crucial to ensuring

that the ultimate aim of all medical research, to improve patient outcomes, may be

achieved.

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47. Bliss LA, Ross-Richardson CB, Sanzari LJ, Shapiro DS, Lukianoff AE, Bernstein BA, et al. Thirty-day outcomes support implementation of a surgical safety checklist. J Am Coll Surg 2012; 215:766-76.

48. Pucher PH, Aggarwal R, Darzi A. Surgical ward round quality and impact on variable patient outcomes. Ann Surg 2014; 259:222-6.

49. Pucher PH, Aggarwal R, Singh P, Srisatkunam T, Twaij A, Darzi A. Ward simulation to improve surgical ward round performance: A randomised controlled trial of a simulation-based curriculum. Ann Surg 2014 Mar 30.

20

Figure 1. Flowchart of literature search results.

Records screened(n = 970)

Full-text assessed for eligibility(n = 20)

Studies included in final data

synthesis(n = 19)

Exclusion of irrelevant results(n =

950)

Did not meet inclusion criteria

(n = 4)

Additional results from hand-searching of references

(n = 3)

21

Table 1. Demographic details of included studies

Author Specialty Study type Handovern (control)

n (intervention)

Karakaya, 2013, Belgium22

Pediatric cardiac surgery

Pre-/post-intervention cohort

Operative to PICU team

23 25

Nagpal, 2013, UK12

General and vascular surgery


Daily handover 50 40

Agarwal, 2012, USA23




61 114

Ahmed, 2012, UK24

General surgery Pre-/post-intervention cohort


Craig, 2012, UK25 Pediatric cardiac surgery



21 22

Petrovic, 2012, USA26

Cardiac surgery Pre-/post-intervention cohort

Operative to ICU team

30 30

Wohlauer, 2012, USA27

Medicine and surgery



Clark, 2011, USA28


Daily handover n/r n/r

Joy, 2011, USA29 Pediatric cardiac surgery



41 38

Ryan, 2011, ROI30

General, vascular surgery



Telem, 2011, USA31


Patient handover 20 38

Zavalkoff, 2011, Canada32




15 16

Stahl, 2009, USA33

Trauma surgery Pre-/post-intervention cohort

Morning and evening handover

119 213

Ferran, 2008, UK13

Orthopedic surgery



Mistry, 2008, USA34




29 142

Wayne, 2008, USA35

General, vascular, transplant, cardiothoracic surgery


Daily handover 187 total

Catchpole, 2007, UK36




23 27

Van Eaton, 2005, 2010 USA37, 38

General surgery, medicine

Multi-centre randomized trial, two teaching hospitals

Daily handover 1365 total

PICU: paediatric intensive care unit, ICU: intensive care unit

22

Table 2. Methods, endpoints, and summary results of included studies

Reference

Intervention

(Development process) Training Endpoint Key results22 Checklist (literature review) n/r Checklist compliance; time taken Improved completeness of handover (48% to 73%,

p<0.001), duration reduced from 6 to 4 mins (p=0.04).12 Handover proforma (multi-source:

interview, Delphi, pilot study)n/r Omissions; task errors; teamwork

score; Likert satisfaction score; time

Reduction of omissions (9 vs. 3, p<0.001), task errors (2.8 vs. 0.8, p<0.001), improved teamwork (median score 3 vs. 4, p<0.001), nurses satisfaction (4 vs. 5, p<0.001), time unchanged.

23 Standardized handover procedure, proforma (based on staff feedback)

Staff training, pilot sessions

Information transfer; subjective quality; postoperative complications; rates of early extubation

Improved completeness of handover (57% vs. 84%). Reduced complication rates (24% vs. 12%, p<0.001), increased early extubation (43% vs. 50%, p<0.04).

24 Computerized handover template (expert guidelines)

Didactic; written information pack

Checklist compliance Improved completeness of handover (60% vs. 92%)

25 Standardzed handover procedure, checklist (literature review, staff workshop feedback)

Didactic; written information pack

Checklist compliance; subjective quality score; staff questionnaire

Significant improvement in handover quality, fewer omission errors

26 Standardized handover procedure (focus group)

Didactic Task errors; satisfaction questionnaire

Reduction of omitted items (19% vs. 17%, p<0.05). Satisfaction scores increased (61% vs. 81%)

27 Computerized handover tool (survey, based on UoW CORE)

n/r Time taken; frequency of patients missed on ward round

Reduced frequency of missed patients, reduction in pre-rounding time (63 vs. 52 min, p=0.006)

28 Computerized handover tool, structured handover procedure (based on UoW CORE)21

Didactic Checklist compliance Adequacy of handovers increased from 73% to 80-98%

29 Standardized handover procedure, Didactic Task errors; teamwork Technical errors reduced (6.24 vs, 1.52, p<0.0001), omissions reduced (6.33 vs. 2.38, p<0.0001),

23

checklist (FMEA, RCA) teamwork improved (p<0.05)30 Computerized handover template

(expert guidelines)n/r Length of stay Median length of stay reduced from 5 days to 4 days

(p=0.047)31 SBAR communication tool Didactic; simulation-

based practiceTask errors; sentinel events Order entry errors better post intervention (14.5% vs

12.2%, p=0.003). No difference in controls not undergoing SBAR training.

32 Handover proforma (limited staff consultation)

Informal Checklist compliance Handover score improved (28.2 vs. 33.5, p=0.002)

33 Checklist (adapted from transport industry protocol)

Didactic Task errors Reduction of omissions (20.1 vs. 3.6%, p<0.0001).

13 Handover proforma (expert guidelines)

n/r Checklist compliance Significant improvement in performance (overall figures not given).

34 Standardized handover procedure (adapted from industry)

Practice sessions; TeamSTEPPS

Time; clinical task completion rate

Reduced time (15.3 vs 9.6 mins, p<0.001) and time to obtain lab studies (13 vs 2.4 mins, p<0.001), greater x-ray completion rate (60% vs. 94%, p<0.01).

35 Computerized handover template (staff questionniare)

n/r Task errors Fewer inaccuracies with sign-out sheet (p=0.003), improvement in completeness (p=0.015), clarity (p=0.0001).

36 Standardized handover procedure (based on aviation and motorsport models)

Practice session, feedback by aviation experts

Task errors Reduction of errors (5.42 ± 1.24 vs. 3.15 ± 0.71).

37, 38 Computerized handover tool (residents focus group)

n/r Patients missed on ward round; time spent on ward round; adverse events

Reduction in missed patients (2.5 vs 5 per month, p<0.001), proportion of pre-round time spent copying results (24% vs. 12%, p<0.001), no difference in adverse events.

n/r: not reported, FMEA: failure mode effects analysis, RCA: root cause analysis, SBAR: situation-background-assessment-recommendation

24

Table 3. Quality assessment of studies

Reference

Quality

score

(NOS) S H A R E22 6 X X X12 6 X X X23 6 X X X X24 3 X X X25 5 X X X X26 3 X X X27 4 X X28 6 X X X X X29 5 X X X X30 3 X X31 5 X X X32 8 X X X33 4 X X X X13 4 X X X34 4 X X35 3 X X36 5 X X37, 38 2* X X

NOS: Newcastle Ottawa Score. *Jadad score

25

Documents

spiral.imperial.ac.uk€¦ · Web viewEffectiveness of interventions to improve patient handover in surgery: A systematic review. Philip H Pucher, MD, MRCS1, Maximilian J Johnston,