Evaluation of Intraoperative Hand-Off Frequency, Duration, and Context: A Mixed Methods Analysis

J Surg Res. 2020 Dec;256:124-130. doi: 10.1016/j.jss.2020.06.007. Epub 2020 Jul 17.


Background: Hand-offs in the operating room contribute to poor communication, reduced team function, and may be poorly coordinated with other activities. Conversely, they may represent a missed opportunity for improved communication. We sought to better understand the coordination and impact of intraoperative hand-offs.

Methods: We prospectively audio-video (AV) recorded 10 operations and evaluated intraoperative hand-offs. Data collected included percentage of time team members were absent due to breaks, relationships between hand-offs and intraoperative events (incision, surgical counts), and occurrences of simultaneous hand-offs. We also identified announcement that a hand-off had occurred and anchoring, in which team members not involved in the hand-off participated and provided information.

Results: Spanning 2919 min of audio-video data, there were 74 hand-offs (range, 4-14 per case) totaling 225.2 min, representing 7.7% of time recorded. Thirty-two (45.1%) hand-offs were interrupted or delayed because of competing activities; eight hand-offs occurred during an instrument or laparotomy pad count. Six cases had simultaneous hand-offs; two cases had two episodes of simultaneous hand-offs. Eight hand-offs included an announcement. Seven included anchoring. Evaluating both temporary and permanent hand-offs, one or more original team members was absent for 40.7% of time recorded and >one team member was absent for 20.5% of time recorded.

Conclusions: Intraoperative hand-offs are frequent and not well coordinated with intraoperative events including counts and other hand-offs. Anchoring and announced hand-offs occurred in a small proportion of cases. Future work must focus on optimizing timing, content, and participation in intraoperative hand-offs.

Keywords: Communication; Intraoperative hand-offs; Teamwork; Transitions in care.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Communication
  • Humans
  • Intraoperative Care / statistics & numerical data*
  • Operating Rooms / organization & administration
  • Operating Rooms / statistics & numerical data*
  • Patient Care Team / organization & administration
  • Patient Care Team / statistics & numerical data*
  • Patient Handoff / statistics & numerical data*
  • Prospective Studies
  • Qualitative Research
  • Quality Improvement
  • Time Factors
  • Video Recording / statistics & numerical data