Mixed Methods Study of Perioperative Handoffs: Current State and Opportunities for Improvement

Background: Patient handoffs are a critical component of safe and effective healthcare delivery, yet they remain a major source of communication failure and medical error, particularly in complex, high-acuity environments such as perioperative care. While structured handoff programs have demonstrated success in inpatient settings, their applicability to the multidisciplinary and fast-paced perioperative environment remains unclear. This study aimed to assess current handoff practices, workflows, and teamwork training to inform adaptation of a structured handoff program for perioperative use. Methods: A mixed methods needs assessment was conducted at a large academic medical center, consisting of an online survey and focus groups and individual interviews with perioperative providers across the day surgery unit, operating room, post-anesthesia care unit, and intensive care unit. The survey included approximately 30-35 items assessing handoff processes, teamwork behaviors, training experiences, workflow constraints, and implementation factors. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using thematic analysis to identify key patterns and themes. Results: A total of 128 providers completed the survey and 43 participated in focus groups or interviews. Findings revealed variability in handoff training and a lack of standardized processes across roles. Only 29% of operating room nurses reported a standardized handoff process, compared to 57% in intensive care settings. Role ambiguity was common, with disagreement across disciplines regarding responsibility for leading handoffs and providing patient care during transitions. Time pressure and limited protected time further constrained effective communication, with 55% of post-anesthesia care unit respondents reporting time-related barriers. Qualitative findings highlighted fragmented communication, lack of shared mental models, and frequent omissions of critical information. Participants consistently emphasized the need for structured written tools, clearer role delineation, and team-based training to support effective handoffs. Conclusion: Perioperative handoffs are characterized by variability in practice, role ambiguity, and workflow constraints that may compromise communication and patient safety. A tailored approach to adapting structured handoff programs, combined with standardized tools, team-based training, and workflow support, may improve coordination and reduce communication failures in this setting.