A Systematic Review of Postoperative Care Transition Interventions: Examining the Implementation of Handoff Protocols and Checklists.

Abstract

Perioperative care transitions or handoffs represent a high-risk period frequently compromised by communication failures and the loss of essential patient information. Handoffs play a pivotal role in mitigating these risks. A comprehensive assessment of implementation and clinical outcomes is essential to identify protocols that enhance patient safety, improve care quality, and support reproducibility. This study identifies and synthesizes existing evidence on handoff strategies, evaluating their impact on both implementation success and clinical outcomes. A systematic search of PubMed, EMBASE, and CINAHL databases was conducted to identify observational and descriptive studies addressing preoperative, intraoperative, and postoperative handoffs. Eligible studies were published in peer-reviewed, English-language journals. The selection process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and study quality was evaluated using the Quality Scoring System. Eleven studies evaluating the impact of handoff interventions on both implementation and clinical outcomes were included. Key implementation outcomes, including sustainability and acceptability, were commonly assessed through staff satisfaction surveys. Clinical outcomes included length of stay, duration of mechanical ventilation, and pain scores. All studies incorporated a structured preimplementation planning phase and reported significant improvements in at least 1 implementation outcome, with acceptability being the most consistently improved measure. Each study demonstrated meaningful improvements in at least 1 implementation outcome, while 7 of 11 studies reported significant enhancements in clinical outcomes. The consistent success of various methodologies-whether through expert consultation, frontline involvement, or quality improvement strategies-indicates that a tailored, site-specific approach may be more critical to success than the specific intervention strategy used.