Assessment of Postoperative Handover Communication Practice among Perioperative Staff in Orthopedic Surgery: Implications for Surgical Outcomes

Abstract

Objective: To assess the quality of handover practice from Operating Room to Postanaesthesia Care Unit (PACU) in an orthopedic surgical context and to determine shortcomings in communication using Situation-Background-Assessment-Recommendation (SBAR).

Methods: This was a cross-sectional observational study carried out at Zaid Surgical Hospital, Lahore. Consecutive sampling was used in the direct observation of 155 postoperative orthopedic handovers, and they were assessed against a 39 item SBAR linked checklist. The data analysis was conducted in SPSS; the p Related-Samples Friedman Test, with Bonferroni corrected pairwise comparisons was used to assess differences in completeness across the 4 SBAR sections.

Results: The mean completeness measure across the 39 items of the checklist was at 23.5% (out of 100%). The Situation section was the most completely communicated section (77.0%; Patient Name, Procedure, and Surgeon each at 100%), while the Background, Assessment, and Recommendation sections were communicated far less consistently (17.0%, 18.4%, and 11.9% respectively). The ASA Classification, Drug Allergies, and Postoperative Concerns/Alerts were never communicated. The Friedman Test indicated a statistical difference across sections (p < 0.001); all pairwise comparisons were statistically significant except for Background vs. Recommendation (p = .955). All 155 handovers fell in the Poor completeness (<50%).

Conclusion: Completeness of the postoperative handover in this orthopedic context is poor with situational and procedural facts prioritized over the background, assessment, and recommendation components. SBAR standardization using mandatory standardized measures has the potential to be a viable solution along with targeted staff training.