The Post-Operative Handoff: Perceptions and Preferences of Pediatric Hospitalists and Surgeons.

Abstract

Postoperative communication errors contribute to patient harm and excess costs. There are no existing standards for postoperative handoff to the acute care inpatient unit. We aimed to compare the experiences and preferences of pediatric hospitalists and surgeons about the content and timing of this handoff. We conducted a cross-sectional multisite survey of pediatric hospitalists and surgeons at 4 hospitals using a novel survey tool developed through a systematic 7-step process. We collected data on the perceived frequency of communication for 37 handoff elements and how essential each element was for an ideal handoff. We used 5-point Likert scales of communication frequency and essentialness. Respondents identified perceived and preferred handoff timing. Mention frequency and timing data were analyzed with the Mann-Whitney U test and Fisher's exact test, respectively. Seventy hospitalists (61%) and 27 surgeons (25%) responded to the survey. Over half of both hospitalist and surgeon respondents rated 13 handoff elements a 5 on the essentialness Likert scale. Surgeons perceived that 33 handoff elements were mentioned significantly more frequently than perceived by hospitalists (P < .05). Of hospitalists, 58% preferred that handoff occur immediately before the patient leaves the postanesthesia care unit. Of surgeons, 60% preferred that handoff occur immediately postoperatively. The 13 core elements we identified may facilitate the development of a standardized handoff checklist for postoperative communication between surgeons and hospitalists on acute care units. Areas of future study could include checklist validation, audits of handoff practice, and qualitative research on handoff preferences.