Surgical Handover Research Articles

EP120 - A Retrospective Review of Pregnant Patients Referred to an Emergency General Surgery Service

Abstract Aims To gain insight into the journey and outcomes of pregnant patients referred to an emergency general surgery service. Methods Surgical handover lists from Jan 2021-Dec 2023 were reviewed to identify pregnant patients referred to the service. Data was collected from the electronic patient record on demographics, timeline, imaging, diagnosis, management and subsequent delivery method if pregnancy reached term. Results There were 91 referrals of pregnant women to the emergency general surgery service over the 3 year period. 80% were for abdominal pain. 64% of patients received a documented review by a general surgery consultant, and 35% received a documented review by an obstetric consultant. For those presenting with abdominal pain, 79% had imaging other than plain film, the most common being ultrasound abdomen (75%). 5% of patients had an MRI abdomen and pelvis, and 4% of patients had a CT abdomen and pelvis. Of the 21 patients treated for a confirmed abdominal surgical diagnosis who had a documented delivery, 29% required emergency c-sections. In comparison, out of 17 patients who had either non-surgical pathologies or extra-abdominal surgical pathologies, excluding pregnancy-related complications, 0 went on to have emergency c-sections. This is statistically significant (p=0.0241). Conclusion The investigation and management of an acute abdomen in pregnancy poses a number of unique challenges. Our dataset, though small, has hinted at unacceptable rates of consultant review and under-utilisation of cross-sectional imaging. Furthermore, there is the suggestion that patients with confirmed abdominal surgical pathology may be at increased risk of delivering via emergency c-section. There is a need for further research into this patient population.

208 Head and Neck Surgical Oncology Handover Audit Using ‘RAAAIDDSS’ Method

Abstract Background Patient handover is vital in ensuring patient safety and quality of patient care, in line with Royal College of Surgeons Guidance of Safe Handover (2007). ‘RAAAIDDSSS’ method stands for resection (surgery), airway, anticoagulant, antibiotics, intake, drain, Doppler, serology, scans, structure (plans). It shows comprehensive clinical updates for planning best management, ensuring smooth flow of activity and reducing morbidity. This method is ideal as our surgical patients often have altered airway anatomy and airway plans and consequently variable feeding routes. Aim To audit the compliance of RAAAIDDSSS method. Method This is a prospective audit in Head and Neck Surgery Department of University College London Hospital (UCLH), done within 4 weeks across June-July 2023, with sample (n=100) for first cycle and (n=81) for second cycle. The format was implemented in handover sheet and case presentation was run according to this method. Results First cycle showed good compliance to RAAAIDDSSS handover method. The least compliant component is ‘structure’ which showed only 62%. Results were presented in grand ward round. Second cycle showed significant improvement. Almost all components showed 100% compliance, except for the ‘intake’, which was 90%. Overall shows positive compliance to this handover method. Conclusions UCLH Head and Neck Surgery has strict compliance with the RAAIDDSSS method. This audit brings significant positive impacts and changes to clinical practice in terms of patient safety, service efficiency and quality of patient care. This audit also holds valuable clinical value and opens doors for further audits as well as project expansion regionally and nationally.

Surgical Handover Core Outcome Measures (SH-CORE): a protocol for the development of a core outcome set for trials in surgical handover

BackgroundSurgical handover is associated with a significant risk of care failures. Existing research displays methodological deficiencies and little consensus on the outcomes that should be used to evaluate interventions in this area. This paper reports a protocol to develop a core outcome set (COS) to support standardisation, comparability, and evidence synthesis in future studies of surgical handover between doctors.MethodsThis study adheres to the Core Outcome Measures in Effectiveness Trials (COMET) initiative guidance for COS development, including the COS-Standards for Development (COS-STAD) and Reporting (COS-STAR) recommendations. It has been registered prospectively on the COMET database and will be led by an international steering group that includes surgical healthcare professionals, researchers, and patient and public partners. An initial list of reported outcomes was generated through a systematic review of interventions to improve surgical handover (PROSPERO: CRD42022363198). Findings of a qualitative evidence synthesis of patient and public perspectives on handover will augment this list, followed by a real-time Delphi survey involving all stakeholder groups. Each Delphi participant will then be invited to take part in at least one online consensus meeting to finalise the COS.Ethics and disseminationThis study was approved by the Royal College of Surgeons in Ireland (RCSI) Research Ethics Committee (202309015, 7th November 2023). Results will be presented at surgical scientific meetings and submitted to a peer-reviewed journal. A plain English summary will be disseminated through national websites and social media. The authors aim to integrate the COS into the handover curriculum of the Irish national surgical training body and ensure it is shared internationally with other postgraduate surgical training programmes. Collaborators will be encouraged to share the findings with relevant national health service functions and national bodies.DiscussionThis study will represent the first published COS for interventions to improve surgical handover, the first use of a real-time Delphi survey in a surgical context, and will support the generation of better-quality evidence to inform best practice.Trial registrationCore Outcome Measures in Effectiveness Trials (COMET) initiative 2675. http://www.comet-initiative.org/Studies/Details/2675.

Assessing current handover practices in surgery: A survey of non-consultant hospital doctors in Ireland

BackgroundHandovers of care are potentially hazardous moments in the patient journey and can lead to harm if conducted poorly. Through a national survey of surgical doctors in Ireland, this paper assesses contemporary surgical handover practices and evaluates barriers and facilitators of effective handover. MethodsAfter ethical approval and pre-testing with a representative sample, a cross-sectional, online survey was distributed to non-consultant hospital doctors (NCHDs) working in the Republic of Ireland. A mixed-methods approach was used, combining data using triangulation design. Main findingsA total of 201 responses were received (18.5%). Most participants were senior house officers or senior registrars (49.7% and 37.3%). Most people (85.1%) reported that information received during handover was missing or incorrect at least some of the time. One-third of respondents reported that a near-miss had occurred as a result of handover within the past three months, and handover-related errors resulted in minor (16.9%), moderate (4.9%), or major (1.5%) harm. Only 11.4% had received any formal training. Reported barriers to handover included negative attitudes, a lack of institutional support, and competing clinical activities. Facilitators included process standardisation, improved access to resources, and staff engagement. ConclusionsSurgical NCHDs working in Irish hospitals reported poor compliance with international best practice for handover and identified potential harms. Process standardisation, appropriate staff training, and the provision of necessary handover-related resources is required at a national level to address this significant patient safety concern.

649 Closed Loop Audit: Improving Surgical Handover in a Major Trauma Centre (RSCH)

Abstract Aim The goal of handover is the accurate reliable communication of task-relevant information across shift changes or between teams. Effective and safe transfer of clinical information is critical for patient safety. The aim of this study to assess Surgical handover in Royal Sussex County Hospital comparing it to the RCS guidelines as standard as well as improving the current practice. Method We undertook two cycles each cycle lasted for 6 weeks. These cycles aimed to assess the surgical handover and comparing them with RCS guidelines using checklists. A teaching session was conducted between the two cycles. In addition, RCS guidelines were handed over to all surgical doctors. Results we discussed a total of 2348 patients in morning surgical handover, over a period of 12 weeks (first cycle: 1203, second cycle:1145). Following conduction of teaching sessions and handing over guidelines, there was a significant improvement in documentation of patients age (from 73% to 97%), responsible consultant (from 92% to 98%), significant investigations (from 60% to 93%) and management plan (from 64% to 96%). Conclusions Education about proper handover was proven to be successful in improving the quality of surgical handover in a major trauma center.

477 Documentation of Resuscitation Decisions in Surgical Patients in a District General Hospital

Abstract Introduction Every patient admitted into hospital has to have a clear documentation of their resuscitation decisions in their current health charts.1 This enables surgeons to provide the best and sometimes major surgical treatment without delay in the first instance. The aim of this study was to assess the completeness of the resuscitation decisions for surgical patients admitted into our department. Method All patients on our surgical handover list between 22nd August and 31st August 2022 who were admitted were included in this study. Patient charts were reviewed, and data collected in relation to the completeness of the resuscitation decisions and treatment escalation plan (TEP). Results A total of 50 patients were included. 35 patients (70%) had their resuscitation decisions documented whereas 33 patients (66%) had documented TEP. This is in contrast to guidelines as not all of admitted surgical patients had their resuscitation decisions or TEP documented. Our planned interventions were highlighting its importance in a virtual departmental meeting, educating new incoming junior doctors, sending departmental reminder emails and making the section of the proforma a mandatory field to complete. Conclusions Documentation of resuscitation decisions is important in providing quality of care for patients. Our result showed intervention is needed to ensure best practice is adhered to. We plan to achieve a better data completeness in our next audit cycle after intervention.

AB070. SOH23ABS_202. A systematic review of interventions to improve daily handover in surgery

Background: Poor quality handovers lead to patient harm and surgical teams receive little training in this area. This systematic review provides an up-to-date assessment of the types of interventions available to improve daily surgical handover.

Reengineering Surgical Patient Transfer and Handover Process in Operating Room

Objective: To reform the transfer process of surgical patients, standardize the transfer process, and improve the quality of safe transfer; unify the intrahospital transfer process to achieve standardized management; ensure patient safety, improve work efficiency, and reduce the occurrence of adverse events. Methods: A transfer team was formed, a handover record sheet for surgical patients was designed, and the workflow and specifications for handover and transfer of surgical patients were formulated. Results: After using the re-designed handover record sheet for surgical patients and improving the procedure for transferring surgical patients, the accuracy of surgical patient handover was ensured, the handover and transfer time was shortened, and the surgical turnover rate improved. Conclusion: By designing and reforming the service model, it is possible to change and standardize the transfer process of surgical patients and improve the quality of safe transfer, the operating room management system so that it is more rational and humanized, the management model, the working environment, as well as the overall quality and efficiency of operating room nursing.

SP2.2.11Improving the quality of the documented weekend surgical handover: Implementation of a handover sticker within an urban teaching hospital

Abstract Aim Effective, high-quality patient handovers between the surgical team are essential for safe transfer of responsibility for patient care whilst ensuring continued patient-safety and supporting good clinical governance. Weekend handovers provide a particular challenge, with error potential, when patients are cared for by multiple different healthcare professionals. This project aimed to improve the documentation of the weekend handover for the surgical inpatients of a busy UK teaching hospital. Method Quality Improvement project performed within a single General Surgical department between August and October 2020. An initial casenote audit on 3 consecutive Fridays compared available handover information against RCS guidance. A comprehensive surgical weekend handover sticker was designed and all members of the surgical team educated in its use. Following sticker introduction, handover quality was similarly re-audited. **=p<0.00001 using Chi-squared/Fisher exact. Results 138 inpatient records were evaluated in cycle 1 and 135 in cycle 2, with the proportion containing a weekend handover increased post-intervention (96 vs. 82%,p=0.0004). Handover quality improved following sticker introduction with more frequent documentation of: diagnosis (96 vs. 21%**); need for imaging review (94 vs. 29%**); intravenous fluid plan (84 vs. 21%**); blood test requirements (94 vs. 24%**); mode of nutrition (90 vs. 24%**); antibiotics (90 vs. 30%**); drug monitoring (90 vs. 1%**); discharge planning (94 vs. 44%**) and escalation plan (87 vs. 0%**). Conclusion Introduction of a sticker has significantly improved the quality of documented handover available to the responsible on-call team. Future work will assess sticker impact on quality of care and clinical outcomes.

EP.TU.45Organising The Huddle: An Audit Loop of the Surgical Handover

Abstract Aim Structured patient handover is a critical element for the patient safety. There are several guidelines including the ones from NICE and Royal College of surgeons emphasizing its importance in today’s practice. It entails appropriate coordination and communication among health-care providers to ensure safety of the patients and avoid adverse incidences. This audit was performed to assess and improve the current Surgical Handover Meeting in line with the Handover Guidelines from the Royal College of Surgeons of England (Rcseng.ac.uk, 2007). Method A questionnaire was circulated among the surgical doctors involved in the handover meetings. Outcomes were compared with the NICE and RCS guidelines. Recommended changes were implemented after training the staff which was followed by second cycle of audit. Results During the first cycle of audit, 80% of the junior surgical doctors contributed towards the study who agreed there was no standard format of handover, information was incomplete and there was lack of privacy. A standardized handover sheet was introduced which included accurate and concise information about patients with their management plans. There was noticeable improvement in staff satisfaction in second cycle but use of quiet room and nurse’s attendance remained poor. Conclusion Safe handover reflects quality of patient care. Despite achieving remarkable improvement after first audit we still lag behind the recommended practice. With all the support and coordination; further projects, meetings and presentations are required to achieve the outstanding standards.

EP.TU.560Improving surgical handover by implementing a dynamic handover sheet

Abstract Aim Safe and effective handover is paramount to ensuring good patient care and patient safety. The aim of this study was to identify key issues with the current handover sheets and implement a new comprehensive sheet aimed to improve quality of handover and reduce safety issues within a busy DGH general surgery department. Methods A prospective dynamic study was performed. Retrospective data was obtained by sending out questionnaires to all junior and senior staff. The questionnaire aimed to assess key issues with the original handover sheets and collect qualitative data of perceived safety and efficiency. A dynamic handover sheet was developed using Microsoft Excel and Microsoft Visual Basic. After 2 months of using the new handover sheet, repeat questionnaires were sent out to assess its impact. Results There were 26 responses to the pre-intervention and 14 to the post-intervention questionnaire. 14/26 (54%) reported safety issues, mainly patients being missed at weekend ward rounds or missing handovers from elective teams. Post introduction of the comprehensive sheet 6/14 (43%) reported safety issues, mostly related to user error. Subjective list accuracy improved from 59.0% to 65.3% and accuracy for weekend wardrounds improved from 58.4% to 61.3%. Subjective efficiency of the list improved from 52.5% to 71.5%. Conclusion The new, dynamic handover sheet has led to an overall improvement in safety and efficiency of handover. An easy to understand instruction sheet has been designed to further improve usability and to ensure a lasting effect to mitigate against the inherent risk of junior doctor change-over.

961 ROSE's Proforma: A Tool to Improve Quality and Safety of Surgical Handover

Abstract Aim Accurate and rigorous handover is paramount in surgery. Human factor can unfortunately affect handovers resulting unsafe for patients. The ROSE’S handover proforma is a structured methodology which has been created according to the RCSEng guidelines to facilitate communication ensuring an effective delivering of information concerning the care of surgical patients. Method ROSE is the acronym for REASON, OBSERVATION, SHIFT, ESCALATION and it is made of multiple subparts that cover the majority of the information that need to be shared between team members such as wound care, NEWS score, medications, diagnostic tests, assessments of lines (catheter, cannula, drain, CVC), social situation, deterioration, medical history as required by guidelines of RCSEng. The timing of 40 handovers has been recorded, of these 20 were performed by using the ROSE’s form. A questionnaire has been administered before and after the implementation of the Rose’s handover. Results The average time for handover a surgical patient increased from 1.07 to 3.26 minutes with ROSE’s form. The 82.14% of the staff who tried it thought that the form resulted easy to navigate, brief and complete in details. It is a safer practice for the 71.43% of the staff. The quality and the accuracy of the handover given was perceived as improved by the 96.46% of the staff that used it. Conclusions A structured surgical handover performed with a written form can be an easy and safe tool that can minimize human factor and technical errors especially out of hours. Clearly further research is needed; however, the preliminary results look encouraging.

1248 “Passing the Surgical Torch”- A Review of Appropriate Surgical Handover Protocol on The Acute Surgical Take

Abstract Aim Effective handover between shifts is vital to protect patient safety. The Royal College of Surgeons has detailed the necessary information needed for each patient at handover. We aimed to assess compliance with this handover protocol. Method Weekday surgical handover was reviewed over an 8-week period of time. Data was collected on documentation of diagnosis, up to investigations/bloods, clinical state of patient, management plan and resuscitation status/ceiling of care and COVID status. Results 210 patients were reviewed. Of these, a clear diagnosis was documented for 152 patients. Up to date imaging results if applicable was documented in 111 of 153 patients. Up to date bloods were included in 140 of 210 patients. COVID status was only noted in 31 of 210 patients and DNAR status in only 24. After re-audit of 197 a clear diagnosis was seen in 183 patients, COVID status was documented in 170 patients and DNAR status in 169. Conclusions Surgical handover is hugely crucial for provision of patient care. Following clear guidance from the royal college of surgeons, better compliance with handover was noted, including a critical improvement in COVID and DNAR status.

485 Optimisation of The Evening Surgical Handover Process in A Large Tertiary Surgical Department - A Quality Improvement Project

Abstract Introduction The aim of the project was to improve the quality and effectiveness of the evening surgical handover in a large tertiary surgical department, incorporating up to 150 patients. Method Audit standards were derived from GMC and RCSEng guidelines. An initial audit of the evening handover was conducted over a period of two weeks. Following this, a standard operating protocol (SOP) was introduced, with re-audit 4-weeks following implementation. Results The initial audit identified an inconsistent format and significant variability. Few handovers commenced with all team members present (11%) and were uninterrupted (33%). A laminated handover SOP checklist was produced and a new proforma was introduced to document tasks or reviews required overnight. A mandatory evening surgical HDU round was invoked and a “watchers” system was introduced to identify patients at highest risk of deterioration. Re-audit demonstrated significant improvements in all domains to > 85%. ICU referrals overnight decreased from 6% to 2%. Further improvements measures were implemented in the form of a dynamic virtual handover document. Conclusions A structured SOP improved the consistency of the handover process. A night review of all HDU patients reduced the rate of ICU referrals. Implementation of virtual handover processes may be required in the COVID-era.

299 Implementing A Formal Surgical Handover Tool for Junior Doctors – A QI Approach

Abstract Introduction An informative medical handover facilitates safe patient care. It was recognized that insufficient clinical information at handover resulted in unsafe communication in the general surgical department at Pinderfields General Hospital (PGH). We aim to utilise the Royal College of Surgeons’ (RCS) and British Medical Association’s (BMA) guidelines to improve the existing handover system, facilitate an efficient and relevant handover, and furthermore improve patient safety. Method General surgical foundation doctors (FDs) (n = 15) at PGH were surveyed to establish their perspectives of existing handover documentation. Subsequently a handover tool was iteratively designed, using tests of change, combining RCS and BMA guidelines with FDs’ suggestions of patient information required for safe handover. At two time points, FDs in the department were re-surveyed to measure improvement. Results Prior to implementation of a formal document, only 20% of FDs reported sufficient patient identifiers of the handover. This improved to 67% post intervention. Pre-intervention, 0% perceived the handover as ‘Excellent’, 20% as ‘good’. Post-intervention, these improved to 34% and 60% respectively. Conclusions Over six months, we improved the FD’s handover document, resulting in positive feedback of perceived safety of surgical patient handovers. However, recognised time constraints have highlighted the need for more efficient handover documentation.

Mortality in Australian Cardiothoracic Surgery: Findings From a National Audit

Independent peer review of mortality cases has potential to identify issues in cardiothoracic surgical patients. The Australian and New Zealand Audit of Surgical Mortality aims to improve surgical care through peer-reviewed assessment of all surgical mortality. The aim of this study was to describe common clinical management issues that contribute to patient mortality in a cohort of Australian cardiothoracic surgical patients. This approach may subsequently provide a basis for quality improvement. Cardiothoracic mortality reports to the Australian and New Zealand Audit of Surgical Mortality from February 2009 through December 2015 were reviewed. The surgeon report and assessor comments were coded to identify clinical management issues. These were divided into perioperative stages (preoperative, intraoperative, and postoperative), and at each stage a thematic analysis was performed. Of the 908 cases analyzed, 1371 clinical management issues were identified. Postoperative issues were the most common (n= 552), followed by preoperative (n= 378) and intraoperative issues (n= 370). Communication issues were present at all 3 stages (n= 71). Overall the most common theme was intraoperative technical issues (n= 287). Many of these issues revolved around unintentional injury to anatomic structures during surgery and inadequate myocardial protection. Communication issues commonly related to surgical handover to the intensive care unit and lack of shared decision-making. Also common were consultant surgeons being unaware of patient deterioration or significant changes in management. The Australian and New Zealand Audit of Surgical Mortality provides valuable insights into issues affecting mortality in cardiothoracic patients. Potentially avoidable management issues play a large role in determining the outcome of these patients. Quality improvement initiatives targeting these areas may be valuable.

Early warning of nursing risk based on patient electronic medical record information

In order to study the nursing risk warning of patients’ electronic medical record (EMR) information, data of 200 cases of patient from Eastern Medical District of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital is selected. The Logistic regression model and nursing risk warning information system are used to calculate the death probability of the recovered patients 24h before discharge and 24h before the death of the patients. The predictive ability of the system is verified, and incidence of infusion, blood transfusion, surgical patient handover, blood sample collection nursing risk, and corresponding indirect care hours before and after the use of nursing risk warning are compared. The probability of death of the recovered patients within 24h before discharge is less than 0.5, and the death probability of the dead patients before the death of 24h is greater than 0.5. After the nursing risk warning is used, the infusion, surgical patient handover, and incidence of blood sample collection nursing risk are significantly lower than those before using the nursing risk warning and the difference is statistically significant. The indirect nursing hours of infusion, blood transfusion, surgical patient handover, and blood sample collection are significantly lower than those before using the nursing risk warning, and the difference is statistically significant. Therefore, the predictive ability of the patient's EMR information risk warning system has important reference value in clinical nursing, which can significantly reduce the incidence of infusion, surgical patient handover, and blood sample collection and nursing risk, reduce the infusion, blood transfusion, surgical patient handover, and indirect nursing hours for collecting blood samples, and improve the quality and efficiency of hospital diagnosis and treatment.

Establishment and application of multidisciplinary chain management model based on information technology in surgical patient handover

Objective To explore the clinical application of information technology in the multidisciplinary chain management of surgical patient handover, in order to reduce the safety hazard in the process of surgical patient handover. Methods In the contemporary controlled study, 300 patients were selected as the control group from February to July 2017 by cluster sampling, and 303 patients were selected as experimental group from February to July 2018. Traditional sectional handover method was adopted in the control group, to managed the patients' handover from each section. In the experimental group, based on the information communication platform between the surgery room and relevant clinical departments, by clinical electronic documents chain transfer method, quality inspection and supervision information feedback technology, to achieve shared decision and improvement of patients handover problems, we built the multidisciplinary management pattern. The two groups were compared for statistical difference from six aspects: the rate of acceptance specification, the accuracy of identity verification method, the rate of operation labeling verification, the accuracy of inventory of items, the evaluation of pipeline patency, and the evaluation of skin condition at the compression site. Results The rate of standard delivery of surgical patient handover increased from 49.33% to 92.08% in the two groups. The experimental group was better than the control group in the rate of correct delivery of handover from the following five aspects: identity recognition, indication of surgical site, inventory of articles carried, unobstructed pipeline and skin state of the pressure site with statistical significance (P<0.01) . Conclusions The multidisciplinary chain management model of surgical patient handover supported by information technology is effective in clinical application, which can significantly reduce the risk of hazard in patient handover and is worthy of clinical promotion. Key words: Information technology; Chain management; Patient handover; Multidisciplinary

Structured Handover in General Surgery: An Audit of Current Practice.

Verbal handover alone compromises patient safety, and supporting written documents significantly increases retention of information, with printed handover sheets being the best at avoiding data loss. The Royal College of Surgeons (RCS) has produced guidelines on safe handover practice, in which a minimum dataset is recommended for inclusion when handing over patients to incoming surgical teams, and studies have indicated better adherence to these guidelines when preprinted handover proformas are used. All surgical handover sessions were attended for a one-week period, and copies of handover sheets were taken. These were analyzed against RCS guidelines on the essential dataset for safe handover practice. A standardized handover sheet, developed in accordance with these guidelines and designed to encourage impartation of this minimum dataset, was then circulated among members of the surgical department and made readily available on wards. After a 6-week period, a postintervention audit was conducted using the same methods. Striking differences were seen in the quality of information handed over preintervention and postintervention. The documentation of patient location increased significantly (56%-87%, P < 0.0001; 95% CI, 0.460-0.151), as did the documentation of important outstanding clinical tasks (45%-89%, P = 0.004; 95% CI, 0.439-0.089). Documentation of blood results increased (P < 0.0001; 95% CI, 0.523-0.226), and the proportion of patients for whom the occurrence of a senior review was documented increased from 28% (18) to 85% (45) (P < 0.0001; 95% CI, 0.717-0.419) CONCLUSIONS: The use of a structured, computer-generated handover proforma significantly improved compliance with RCS guidelines within the surgical department of our hospital, and we recommend its continued use among on-call surgical teams.

An Electronic Handover System to Improve Information Transfer for Surgical Patients.

Proper clinical transfers of patient care (known as handovers) are important to patient safety. The aim of this study was to investigate the efficacy and satisfaction of an electronic system for clinical transfers of patients with complex surgical procedures. The design was a single-center observational study auditing the handover process. The electronic handover system combined with an electronic health record system was developed to help verbal handover. The system has a checklist to guide the structured handover process and provided information from the health record system. With the system, the elapsed time for surgical handover decreased from 10.5 to 5.4 minutes. The questionnaire analysis showed that clinician satisfaction with surgical handover increased from 69.4% to 79.3%, and the perception of communication completeness increased from 67.2% to 81.6%. The electronic handover system improved communication for the transfer of care for surgical patients.