Authors: Duffy CC et al.
Anesthesia & Analgesia. 141(6):1237–1244, December 2025.
Summary
This systematic review examined perioperative postoperative care transition (handoff) interventions, focusing specifically on how handoff protocols and checklists are implemented and whether they improve clinical outcomes. The authors highlight that handoffs are a high-risk period for communication failures and loss of critical patient information, and that real-world success depends not only on the tool itself but also on how it is introduced, adopted, and sustained.
The team conducted a PRISMA-guided search across major databases (including PubMed, EMBASE, and CINAHL) for peer-reviewed English-language observational and descriptive studies evaluating perioperative handoff interventions that reported at least one implementation outcome and at least one clinical effectiveness outcome. Eleven studies met inclusion criteria. Notably, all included studies addressed postoperative handoffs only, primarily OR-to-ICU transitions (9 studies) and less commonly OR-to-PACU transitions (2 studies). No eligible studies evaluated preoperative or intraoperative handoffs, underscoring a major gap in the literature.
Across studies, implementation outcomes were most commonly measured through staff surveys and workflow assessments, with acceptability being the most consistently improved outcome. Sustainability was assessed in about half of studies and was generally favorable, though not universal. Fidelity and adherence monitoring appeared more developed in protocol-based interventions than checklist-only approaches; for example, some studies tracked completion of protocol steps and one used video review to assess adherence to best practices.
Clinical outcomes were improved in some, but not all, studies. Seven of eleven studies reported statistically significant improvement in at least one clinical outcome (examples included duration of mechanical ventilation, ICU or PACU length of stay, and pain scores), but results were mixed and heterogeneous. The overall message was that multiple implementation approaches (expert-led consensus, frontline co-design, or quality improvement methods like PDSA cycles) can be successful. The review suggests that tailoring the intervention to local workflow, culture, and barriers may be more important than choosing any single “best” checklist or mnemonic.
Key Points
Handoff interventions that include structured preimplementation planning consistently improved at least one implementation outcome, especially acceptability.
Most evidence in perioperative handoffs centers on OR-to-ICU transitions; there is a clear gap in preoperative and intraoperative handoff implementation research.
Protocol-based interventions commonly included training and fidelity monitoring, whereas checklist-only approaches were less often linked to fidelity measurement.
Clinical benefits were reported in a majority of studies, but results were inconsistent across outcomes like ventilation duration and length of stay.
A tailored, site-specific approach, with early stakeholder engagement and practical workflow integration, appears to be a key driver of success and sustainability.
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