Barriers to Effective Perioperative Handoffs: An Interview-Based Qualitative Descriptive Study

BACKGROUND: Miscommunication is the leading cause of hospital medical error, most occurring during patient care handoffs. Even with successful implementation of a standardized handoff methodology, our hospital experienced continued handoff problems in the perioperative space. No studies have yet examined barriers to effective perioperative handoff communication. PURPOSE: This study aims to identify and understand the barriers to effective perioperative handoffs that persist despite quality improvement efforts to improve handoff communication. METHODS: We initiated a qualitative study using thematic analysis of semistructured face-to-face interviews with nurses and physicians from perioperative units. Interviews were coded into themes and then categories. RESULTS: The barriers were categorized into administration, communication, and personnel. Administration involves knowledge and interpretation of administrative processes. Communication refers to forms and components of handoff communication and the environment where handoffs occur. Personnel refers to individual roles and responsibilities, and also as a quantitative resource. Specific quality improvement initiatives were proposed based on our study results. CONCLUSIONS: Our findings suggest that successful handoff communication between perioperative areas requires identification of critical administrative, communication, and personnel barriers. IMPLICATIONS: Hospitals can conduct similar interview-based studies to discover barriers to effective handoffs, and implement policies and procedures to improve safety in the perioperative space.