Acute general surgery in Canada: a survey of current handover practices

Reducing morbidity and mortality for acute general surgical patients is a fundamental priority. The Institute of Medicine’s 1999 report, To err is human,1 revealed that medical mistakes were one of the leading causes of death in the United States. Surgical patients are not immune to these errors, as was highlighted in a review of 15 000 hospital discharges in Colorado and Utah.2 Surgical care produced 66% of all adverse events, with 54% of those deemed to have been preventable. In Canadian hospitals, the rate of adverse events is estimated to be 7.5%.3 We now know that communication breakdowns are among the most frequent contributors to adverse events in medicine, including serious injury to surgical patients. In their study of communication breakdown in the perioperative period, Greenberg and colleagues4 found that emergency cases and handover of care were especially vulnerable times for information loss. Handovers occur during the transfer of care for an admitted patient from one clinician to another, at which time communication of that patient’s important clinical information takes place. Unlike traditional surgical care models where handover was unnecessary because the patient’s own surgeon was almost always available, today’s acute care surgery (ACS) service model requires multiple handovers to incoming attending surgeons and residents on call. These services were created to address quality of care, education and academic issues.5 However, the lack of patient overlap and increased handover may be creating harms affecting ACS patients. Understanding the impact of this problem is a great priority. This is clearly important when developing an ACS model wherein emergency cases are over-represented and handovers are frequent. However, there has been no study to date that characterizes current handover practices of Canadian surgery residents on an ACS service, and consequently the frequency of harm to Canadian patients arising from problems with handovers remains unknown. Clearly, this is the first step in acknowledging potential safety risks and implementing a standardized approach to handover communication such that surgical patient safety may be improved. Our objectives for this study were to investigate current handover practices in Canadian hospitals that have an ACS service and assess the quality of handover practices in place.