Daily handover in surgery: systematic review and a novel taxonomy of interventions and outcomes

Background Poor-quality handovers lead to adverse outcomes for patients; however, there is a lack of evidence to support safe surgical handovers. This systematic review aims to summarize the interventions available to improve end-of-shift surgical handover. A novel taxonomy of interventions and outcomes and a modified quality assessment tool are also described.Methods Ovid MEDLINE (R), PubMed, Embase, and Cochrane databases were searched for articles up to April 2023. Comparative studies describing interventions for daily in-hospital surgical handovers between doctors were included. Studies were grouped according to their interventions and outcomes.Results In total, 6139 citations were retrieved, and 41 studies met the inclusion criteria. The total patient sample sizes in the control and intervention groups were 11 946 and 11 563 patients, respectively. Most studies were pre-/post-intervention cohort studies (92.7%), and most (73.2%) represented level V evidence. The mean quality assessment score was 53.4% (17.1). A taxonomy of handover interventions and outcomes was developed, with interventions including handover tools, process standardization measures, staff education, and the use of mnemonics. More than 25% of studies used a document as the only intervention. Overall, 55 discrete outcomes were assessed in four categories including process (n = 27), staff (n = 14), patient (n = 12) and system-level (n = 2) outcomes. Significant improvements were seen in 51.8%, 78.5%, 58.3% (n = 9761 versus 9312 patients) and 100% of these outcomes, respectively.Conclusions Most publications demonstrate that good-quality surgical handover improves outcomes and many interventions appear to be effective; however, studies are methodologically heterogeneous. These novel taxonomies and quality assessment tool will help standardize future studies. This systematic review aimed to summarize the interventions available to improve end-of-shift surgical handover. A novel taxonomy of interventions and outcomes and modified quality assessment tool were also described.Of the 6139 screened citations, 41 studies of 23 509 patients were identified, which evaluated the impact of four categories of handover interventions on 55 discrete outcomes. Studies were heterogeneous, and effective interventions included implementing a formal face-to-face handover meeting, an automated electronic handover document, a method to highlight critically unwell patients, ensuring appropriate senior supervision, staff education, and the use of a mnemonic or memory aid to structure patient presentations.Future studies should prioritize these interventions and their effect on patient outcomes, particularly adverse events, ward round reviews and length of stay. The novel taxonomies described also provide a new language with which to describe handover research and create uniformity in future research studies.