RCSI SIM Centre for Simulation Education and Research, RCSI, Dublin, Ireland.
StAR MD Programme, School of Postgraduate Studies, RCSI, Dublin, Ireland.
BJS Open. 2024 Mar 1;8(2). doi: 10.1093/bjsopen/zrae011.
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.
Ovid MEDLINE®, 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.
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.
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.
交接质量差会导致患者出现不良后果；然而，目前缺乏支持安全手术交接的证据。本系统评价旨在总结改善交接班时手术交接的现有干预措施。还描述了一种新的干预措施分类和改良的质量评估工具。
检索截至 2023 年 4 月的 Ovid MEDLINE、PubMed、Embase 和 Cochrane 数据库，以获取有关医生每日院内手术交接干预措施的文章。纳入描述医生间日常住院手术交接干预措施的比较研究。根据干预措施和结局对研究进行分组。
共检索到 6139 条引文，41 项研究符合纳入标准。对照组和干预组的总患者样本量分别为 11946 例和 11563 例。大多数研究为干预前后队列研究（92.7%），且大多数（73.2%）为 V 级证据。平均质量评估得分为 53.4%（17.1）。制定了交接干预措施和结局分类法，干预措施包括交接工具、流程标准化措施、员工教育和使用记忆技巧。超过 25%的研究仅使用文件作为唯一干预措施。总体而言，4 个类别中评估了 55 个离散结局，包括流程（n=27）、员工（n=14）、患者（n=12）和系统水平（n=2）结局。分别有 51.8%、78.5%、58.3%（n=9761 例比 9312 例）和 100%的这些结局显著改善。
大多数出版物表明，高质量的手术交接可改善结局，许多干预措施似乎有效；然而，研究方法存在异质性。这些新的分类法和质量评估工具将有助于规范未来的研究。
