JHQ 318: Barriers to Effective Perioperative Handoffs: An Interview-based Qualitative Descriptive Study-JHQ 318: Article

JHQ 318: Article

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This qualitative descriptive study examined why perioperative handoff problems persisted at a large tertiary military teaching hospital despite successful hospital-wide implementation of the standardized I-PASS Handoff Bundle. Although overall I-PASS compliance was high and incident reports decreased, perioperative units continued to report frequent handoff failures. Researchers conducted 37 semistructured, face-to-face interviews (Nov 2020–May 2021) with perioperative nurses and resident physicians across units spanning pre-op through PACU, inpatient surgical wards, and the SICU, then applied thematic analysis.

Eight themes emerged and were consolidated into three overarching categories of barriers: <strong>administration, communication, and personnel</strong>. Administrative barriers included inconsistent understanding of policies and processes, confusion between I-PASS and SBAR, multiple nonstandard forms, and key documentation gaps—especially incomplete Day of Procedure (DOP) notes and the lack of routine preoperative verbal handoffs from inpatient units/APU to Pre-Op Hold. Interviewees emphasized that I-PASS was typically used for change-of-shift handoffs but not reliably for interunit transfers, where senders often underestimated receivers’ information needs.

Communication barriers involved modality and setting: staff preferred <strong>face-to-face verbal handoffs</strong> supported by a <strong>printed/written tool</strong>, but perioperative handoffs often occurred amid noise, interruptions, and competing tasks. Missing contingency planning and poor synchronization (not all key team members present) further reduced handoff effectiveness.

Personnel barriers reflected staffing constraints (notably in Pre-Op Hold), unclear role expectations (e.g., OR nurse vs anesthesia/surgery provider information ownership), and perceived lack of respect for nursing concerns, which could limit information sharing.

The authors propose targeted improvement initiatives: interactive computerized training, cross-unit focus groups to define shared expectations, streamlining the DOP note into I-PASS-like structure, EMR-integrated auto-populated handoff tools, “handoff timeouts” in quieter locations (implemented in SICU outside patient rooms), and better staffing/role alignment for Pre-Op Hold.

Keywords

perioperative handoff failures

I-PASS Handoff Bundle

military teaching hospital

qualitative descriptive study

thematic analysis interviews

administrative barriers

communication barriers

personnel barriers

Day of Procedure (DOP) note documentation

face-to-face verbal handoff with written tool