title: Evaluation of postoperative handover using a tool to assess information transfer and teamwork.
abstract: OBJECTIVE
  To assess the feasibility, validity, and reliability of a postoperative Handover Assessment Tool (PoHAT) and to evaluate the current practices of the postoperative handover at 2 large European hospitals.
  
  
  BACKGROUND
  Postoperative handover is one of the most critical phases in the care of a patient undergoing surgery. However, handovers are largely informal and variable. A thorough understanding of the problem is necessary before safety solutions can be considered.
  
  
  METHODS
  Postoperative Handover Assessment Tool (PoHAT) was developed through task analysis, semistructured interviews, literature review, and learned society guidelines. Subsequent validation was done by the Delphi technique. Feasibility and reliability were then evaluated by direct observation of handovers at 2 large European hospitals. Outcomes measures included information omissions, task errors, teamwork evaluation, duration of handover, and number of distractions.
  
  
  RESULTS
  The tool was feasible to use and inter-rater reliability was excellent (r = 0.96, P < 0.001). Evaluation of handover at the 2 study sites revealed a median of 8 information omissions per handover at both the centers (IQR 7-10). There were a median of 3 task errors per handover (IQR 2-4). Thirty-five percent of handovers had distractions, which included competing demands for nurse attention, bleeps, and case-irrelevant communication.
  
  
  CONCLUSIONS
  This study has established the feasibility, validity, and reliability of a tool for evaluating postoperative handover. In addition to serving as an objective measure of postoperative handover, the tool can also be used to evaluate the efficacy of any intervention developed to improve this process. The study has also shown that postoperative handover is characterized by incomplete transfer of information and failures in the performance of key tasks.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College, Centre for Patient Safety and Service Quality, London, UK. k.nagpal@imperial.ac.uk
authors.forename: Kamal
authors.initials: K
authors.lastname: Nagpal
authors.forename: May
authors.initials: M
authors.lastname: Abboudi
authors.forename: Lukas
authors.initials: L
authors.lastname: Fischler
authors.forename: Tanja
authors.initials: T
authors.lastname: Schmidt
authors.forename: Amit
authors.initials: A
authors.lastname: Vats
authors.forename: Chhavi
authors.initials: C
authors.lastname: Manchanda
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
authors.forename: Daniel
authors.initials: D
authors.lastname: Scheidegger
authors.forename: Charles
authors.initials: C
authors.lastname: Vincent
authors.forename: Krishna
authors.initials: K
authors.lastname: Moorthy
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration*; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D010360:Patient Transfer / Q000458:organization & administration*; D011182:Postoperative Care / Q000592:standards / Q000639:trends; D016730:Program Development; D015397:Program Evaluation; D015203:Reproducibility of Results; D013514:Surgical Procedures, Operative / Q000379:methods*; D006113:United Kingdom