Navigating the challenges of performing anesthesia handoffs and conducting anesthesia handoff research

Handoffs (ie, the exchange of information and responsibility of a patient from one provider or team to another) are frequent events particularly vulnerable and susceptible to communication breakdowns. The number of handoffs performed each year is “staggering,” with some evidence suggesting that communication failures occur every 8 minutes. Because of such prevalence, problematic handoffs are associatedwith postoperative complications and increased mortality rates. In fact, 30% of all malpractice claims in 5 years were attributed to communication failures, costing $1.7 billion. Even more alarming, the volume of $1 million+ payments and the proportion naming multiple defendants are increasing. Recognizing themagnitude and gravity of the potential problems associated with handoffs, regulatory agencies, administrators, clinicians, and researchers have invested many resources to better understand the nuances surrounding these care transitions and to strengthen handoffs to mitigate corresponding adverse outcomes. There have been some advances in handoff research and in handoffs themselves. Studies have demonstrated the ability to reduce information omissions, improve information transfer and retention, and strengthen handoff performance. Meta-analytic evidence indicates that standardizing handoffs improves handoff outcomes and patient, provider, and organizational outcomes; however, many unanswered questions remain. Anesthesia handoffs (ie, the transfer of information and responsibility of a patient involving at least one anesthesia provider) are a particularly nuanced type of handoff that still requires additional research and understanding. Some evidence exists that anesthesia handoffs may be associated with adverse outcomes. For instance, the role of intraoperative handoffs and their impact on subsequent care has been debated, with some arguing that handoffs are not as troublesome as believed and others arguing that any handoffs can be detrimental. As another example, there is insufficient direction on handoff curriculum development and evaluation. Systematic reviews have begun to provide guidance in terms of tools and strategies to enhance handoff performance although, to date, they are either too focused, leaving out critical components of anesthesia handoffs (eg, reviewing only postoperative handoffs), or they are too broad and go beyond the anesthesia domain, losing applicability. Perhaps these gaps persist due to the particularly challenging nature of anesthesia handoffs and anesthesia handoff research. With this question in mind, the purpose of this paper is threefold: (1) to detail the intricacies of anesthesia handoffs by pointing out their various challenging aspects, (2) to highlight the areas that make conducting handoff research especially difficult, and (3) to provide insights into improving handoff research for the future.