The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units

J Clin Anesth. 2015 Mar;27(2):111-9. doi: 10.1016/j.jclinane.2014.09.007. Epub 2014 Dec 22.


Study objective: To evaluate a new perioperative handoff protocol in the adult perianesthesia care units (PACUs).

Design: Prospective, unblinded cross-sectional study.

Setting: Perianesthesia care unit in a tertiary care facility serving 55,000 patients annually.

Patients: One hundred three surgery patients.

Interventions: During a 4-week preintervention phase, 53 perioperative handoffs were observed, and data were collected daily by a trained observer. Educational sessions were conducted to train perioperative practitioners on the new protocol. Two weeks after implementation, 50 consecutive handoffs were observed, and practitioners were surveyed with the same methodology as in the preintervention phase.

Measurements: Type of information shared, type and duration of procedure, total duration of handoff, number and type of providers at the bedside, number of report interruptions, environmental distractions, and any other disruptive events. Observers also tracked technical/equipment problems to include malfunctioning or compromised operation of medical equipment, such as the cardiac monitor, transducer, oxygen tank, and pulse oximeter.

Main results: A total of 103 handoffs were observed (53 preintervention and 50 postintervention). The mean number of defects per handoff decreased from 9.92 to 3.68 (P < .01). The mean number of missed information items from the surgery report decreased from 7.57 to 1.2 items per handoff and from 2.02 to 0.94 (P < .01) for the anesthesia report. Technical defects reported by unit nurses decreased from 0.34 to 0.10 (P = .04). Verbal reports delivered by surgeons increased from 21.2% to 83.3%. Although the mean duration of handoffs increased by 2 minutes (P = .01), the average time from patient arrival at PACU to handoff start was reduced by 1.5 minutes (P = .01). Satisfaction with the handoff improved significantly among PACU nurses.

Conclusions: The perioperative handoff protocol implementation was associated with improved information sharing and reduced handoff defects.

Keywords: Handoffs; Handovers; PACU; Perioperative; Transfers; Transitions.

Publication types

  • Evaluation Study

MeSH terms

  • Clinical Protocols
  • Communication
  • Cross-Sectional Studies
  • Humans
  • Interprofessional Relations
  • Maryland
  • Medical Errors / prevention & control*
  • Operating Rooms / organization & administration
  • Operating Rooms / standards*
  • Patient Care Team / organization & administration
  • Patient Care Team / standards
  • Patient Handoff / organization & administration
  • Patient Handoff / standards*
  • Patient Transfer / organization & administration
  • Patient Transfer / standards
  • Perioperative Care / standards*
  • Personal Satisfaction
  • Quality Improvement
  • Tertiary Care Centers / standards