There is growing literature studying the role of perioperative handoffs. This has included efforts to understand the extent to which the occurrence of an intraoperative handoff itself is helpful or harmful, interventions to improve handoffs when they occur, and protocols for the transition of a patient to a different care setting (e.g., PACU or ICU) (Anesth Analg 2021;132:1559-62; Crit Care Med 2018;46:1863-4; Br J Anaesth 2021;127:830-3; BMJ Qual Saf 2021;30:513-24). The conversation on this topic has persisted for decades, and it likely would not take long to find a perioperative clinician with an opinion on the matter. It is valuable that work on handoffs continues to be done and adds valuable insight.

As the concept of perioperative handoffs represents a broad range of care areas and practices, the literature varies based on the specific question asked. In a systematic review of intraoperative anesthesia handoffs and handoff tools, Abraham et al. found that the evidence on the effects of intraoperative handoffs and related tools is relatively preliminary and evolving (Anesth Analg 2021;132:1563-75). Nevertheless, prospective tool-based intervention studies to improve intraoperative handoffs reported improvement in outcomes such as information retention, communication, and handoff satisfaction. Their results showed contrasting findings regarding whether the occurrence of handoffs was harmful, with literature suggesting an association with morbidity/mortality and other literature showing no association. In a randomized, multicenter clinical trial published in JAMA, the authors found no significant difference in mortality, readmission, or serious postoperative complications between patients randomized to an intraoperative anesthesia handover during a major surgical procedure and those randomized to no handover (JAMA 2022;327:2403-12). OR to ICU handoff interventions, particularly when part of safety bundles including transfer/communication checklists and protocols, have been shown to lead to improvements in analgesia dosing, information omissions, technical errors, and information-sharing (BMJ Qual Saf 2021;30:513-24). Checklist-based interventions for the OR (or procedural area) to PACU handoff have been associated with improvements in sharing of critical information, handover interruptions, and, in one prospective study, a reduction in PACU hypoxemic events (J Perianesth Nurs 2019;34:834-41; Br J Anaesth 2021;127:962-70). In a set of consensus recommendations on perioperative handoffs from a group convened by the Anesthesia Patient Safety Foundation (APSF), the authors recommended processes such as using setting-specific checklists or cognitive aids, having education and training, and documenting handoffs when they occur (Anesth Analg 2019;128:e71-8). This is all in addition to publications that have found positive outcomes from handoff interventions in other medical settings, such as multisite projects from the Illness severity, Patient summary, Action list, Situation awareness and contingency plans, and Synthesis by receiver (I-PASS) study groups (N Engl J Med 2014;371:1803-12; J Hosp Med 2023;18:5-14). In the consensus recommendations from the APSF group, the authors emphasized the importance of the comprehensive, multidimensional approach used by the I-PASS group to improve handoffs and reduce adverse events. The APSF group also highlighted the importance of factors such as leadership buy-in, involvement of all members of the team, team training, coaching, feedback, and didactic education (Anesth Analg 2019;128:e71-8).

There are important ongoing and future directions regarding perioperative handoffs. Checklists and cognitive aids can improve communication and add to locally customized handoff protocols (Curr Opin Anaesthesiol 2022;35:723-7). For OR to ICU handoffs, the Handoffs and Transitions in Critical Care – Understanding Scalability (HATRICC-US) project has already published their study protocol for a hybrid effectiveness implementation trial across adult and pediatric ICUs (Implement Sci 2021;16:63).

Handoffs may serve an important role within a continuum of perioperative interventions to improve patient safety, including routine safety checklists, crisis checklists, and critical event debriefing (Br J Anaesth 2021;127:830-3). As with similar work on cognitive aids, it will be critical to understand the means of use (e.g., paper vs. electronic) and methods of implementation (Clin Monit Comput 2016;30:275-83; ASA Monitor 2022;86:17). It will also be important for ongoing work to measure both the processes of care improved by the handoff as well as the impact of the handoff on patient outcomes (Crit Care Med 2018;46:1863-4). Overall, handoffs and related interventions represent timely and relevant areas to the landscape of improving perioperative patient safety.