Association of intraoperative anaesthesia handovers with patient morbidity and mortality: a systematic review and meta-analysis

Abstract

Background: Handover of anaesthesia patient care during surgery is common; however, its association with patient outcome is unclear. This systematic review aimed to assess the impact of anaesthesia handover during surgery on patient outcome. Methods: All prospective and retrospective clinical studies specifically investigating the association of intraoperative transfer of anaesthesia care between anaesthesia providers in the operating room with patient morbidity and mortality were included. Searches were conducted from inception to April 24, 2019 in Medline, Medline in Process, CINAHL, and Embase. Reference lists of included studies were searched. Studies were assessed for eligibility and data were extracted by independent reviewers in duplicate with disagreements resolved by consensus or a third reviewer. Risk of bias was assessed in duplicate using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were summarised narratively given substantial heterogeneity. An exploratory metaanalysis was conducted using a random-effects model for a subset of comparable studies. Results: Eight studies met the inclusion criteria. Six studies focused on patients as the unit of analysis (n patients ¼605 678) and two focused on anaesthesia providers as the unit of analysis (n providers ¼307). Seven studies identified a relationship between anaesthesia handovers and adverse patient outcomes, whereas one suggested that handover may be beneficial to error detection or rectification. Included studies were of fair or good quality. Meta-analysis of four studies found a 40% increased risk of patients experiencing an adverse event when an anaesthesia handover occurs during the procedure (pooled risk ratio¼1.40; 95% confidence interval, 1.19 to 1.65; P<0.001; I 2 ¼98%). Conclusions: Intraoperative anaesthesia handovers generally increase morbidity and mortality for surgical patients but could have the potential to improve safety in certain contexts. Future research should determine the specific handover characteristics that impact safety.

Evaluation of a Paper-Based Checklist versus an Electronic Handover Tool Based on the Situation Background Assessment Recommendation (SBAR) Concept in Patients after Surgery for Congenital Heart Disease

“…The possibility of processing more patient data [28], such as patient history and CPB records, makes it especially more comprehensive and easy to use, and user acceptability will, therefore, increase [5]. Intraoperative handover is prone to error and false transmission of information [29]. This can be minimized by an electronic record and handover, improving patient safety and enhancing teamwork and communication [5].…”

Patient safety and staff psychological safety: A mixed methods study on aspects of teamwork in the operating room

“…The current study used a triangulation, mixed methods convergence design to analyze teamwork in the OR (28). It included a retrospective cohort study that used data captured from observations of safety standards in the OR to predict the level of teamwork throughout a surgery; we also conducted purposive recruitment of individuals to participate in semistructured interviews regarding their perceptions of safety in the OR (29).…”

Errors in perioperative antimicrobial use for hospitalized surgical patients

“…Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, 2 Ann Arbor Veterans' Affairs (VA) Medical Center, Ann Arbor, Michigan, 3 Hospitalized patients with severe infections may warrant intravenous (IV) antibiotics and surgical intervention for effective treatment of their infection. Surgical interventions require multiple transitions of care, which are well-studied sources of medicationrelated errors and inappropriate antimicrobial use.…”

“…1 Transitions of care also exist within the operating room and contribute to an increased risk of adverse events. 2 Errors in antibiotic use in the perioperative period may negatively affect patient outcomes. Patients who experience diminished serum and tissue concentrations of antibiotics during surgical closure have higher risks of postoperative wound infections.…”