Postoperative patient handovers are fraught with technical and communication errors and may negatively impact patient safety. We systematically reviewed the literature on handover of care from the operating room to postanesthesia or intensive care units and summarized process and communication recommendations based on these findings. From >500 papers, we identified 31 dealing with postoperative handovers. Twenty-four included recommendations for structuring the handover process or information transfer. Several recommendations were broadly supported, including (1) standardize processes (e.g., through the use of checklists and protocols); (2) complete urgent clinical tasks before the information transfer; (3) allow only patient-specific discussions during verbal handovers; (4) require that all relevant team members be present; and (5) provide training in team skills and communication. Only 4 of the studies developed an intervention and formally assessed its impact on different process measures. All 4 interventions improved metrics of effectiveness, efficiency, and perceived teamwork. Most of the papers were cross-sectional studies that identified barriers to safe, effective postoperative handovers including the incomplete transfer of information and other communication issues, inconsistent or incomplete teams, absent or inefficient execution of clinical tasks, and poor standardization. An association between poor-quality handovers and adverse events was also demonstrated. More innovative research is needed to define optimal patient handovers and to determine the effect of handover quality on patient outcomes.

blood transfusion independently leads to an increase in mortality owing to cardiac ischemia, delayed wound healing, organ dysfunction, and transmission of infection. Patients requiring hip or knee surgery are often anemic preoperatively, and the rate of blood transfusion is relatively high. The authors identified the problems, introduced a simple patient blood management algorithm, and collected data after its implementation. They should be congratulated for reducing the prevalence of preoperative anemia, decreasing blood transfusion rates, and reducing the length of hospital stay. Patient blood management, including simple intraoperative measures such as cell salvage, meticulous attention to hemostasis, and judicious use of tranexamic acid, is just 1 facet of an enhanced recovery pathway. These interventions are becoming increasingly popular and include preoperative optimization, as well as general measures such as maintenance of normothermia, appropriate analgesia prescribing, prophylaxis of postoperative nausea and vomiting, and assessment for deep venous thrombosis risk, all of which are likely to improve overall patient outcome.

We describe an ongoing program that uses in situ simulation to identify and mitigate latent hazards and defects in the hospital emergency response system. The SEIPS model provides a framework for describing and analyzing the structure, processes, and outcomes related to these events.

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An HCD approach led to improvements in the patient handover process from the OR to the ICU in a mixed adult surgical population. Although the specific handover process would unlikely be optimal in another clinical setting if replicated exactly, the HCD foundation behind the redesign process is widely applicable.

As participants monitored more patients in a laboratory setting, their performance with respect to recognizing critical and noncritical events declined. This study has implications for the design of remote telemetry work and other patient monitoring tasks in critical and intermediate care units.

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