A Surgical Handover System for Patient Physiology and Safety.

Abstract

Importance: Ineffective patient handover leads to patient harm, yet no criterion standard exists for safe and effective practice in surgery.

Objective: To determine whether the SIPS (sickest patients first; introduction, situation, background, assessment, recommendation; prioritize; summarize) surgical handover system is associated with improved patient physiology and safety.

Design, setting, and participants: This prospective interventional cohort study included an effectiveness-implementation hybrid design and was carried out between January 2023 and June 2024 at the general surgery departments of 2 tertiary academic hospitals. Physicians participating in postcall (emergency) general surgery handover meetings were included. Data were collected for consecutive patients admitted for emergency general surgery before and after implementation of the intervention, providing they had a minimum of 6 hours of Early Warning Score data available following the time of the handover meeting. Data were analyzed from November 27, 2023, to May, 8, 2025.

Exposure: Staff were trained in the use of a 4-step approach to handover meetings, SIPS, which defines the minimum steps required for safe surgical handover.

Main outcomes and measures: Handover quality, changes in vital signs, length of stay, mortality, escalations in care, staff perceptions of safety, and implementation success were evaluated through handover observations, a retrospective review of patient records, and staff surveys.

Results: Data were collected for 2261 patients, including 1469 patients before the intervention (708 [48.2%] female; mean [SD] age 54.6 [20.3] years) and 792 patients after the intervention (411 [51.9%] female; mean [SD] age 52.8 [20.6] years). A total of 182 residents took part in handovers during the study period, during which time 126 handover meetings were observed. After the intervention, handover quality improved across multiple domains without prolonging meeting duration and was associated with significant improvements in patient vital signs at 12 hours (170 patients [21.5%] vs 247 patients [16.8%]; difference, 4.6 [95% CI, 1.2 to 8.1] percentage points; P = .007) and 24 hours (212 patients [26.8%] vs 294 patients [20.0%]; difference, 6.7 [95% CI, 3.0 to 10.4] percentage points; P < .001). Staff-reported handover-related patient safety events also decreased after the intervention (13 days with events [19.7%] vs 4 days with events [4.6%]; difference, -15.1 [95% CI -4.5 to -25.6] percentage points; P = .004), with improvements in staff-perceived handover safety and quality. Successful implementation was confirmed by high rates of adoption, fidelity, and sustainability.

Conclusions and relevance: In this cohort study, implementation of the SIPS surgical handover system was associated with improvements in handover quality, patient physiology, and staff perceptions of safety without prolonging handover meetings.