Quality of handover in the post-anaesthetic care unit at a quaternary children’s hospital in Cape Town, South Africa: A clinical audit

Background: Postoperative handover involves multidisciplinary collaboration among anaesthesia providers, surgeons and nurses, and the absence of standardised protocols can lead to communication errors that compromise patient safety. The Red Cross War Memorial Children’s Hospital (RCWMCH) lacks a standardised protocol for handover between anaesthesia providers and recovery nurses in the post-anaesthetic care unit (PACU), underscoring the need to evaluate current practices. Aim: To evaluate the quality of postoperative handover between anaesthetists and recovery nurses in the PACU using a standardised checklist. Setting: The PACU of the RCWMCH, a quaternary academic children’s hospital in Cape Town, South Africa. Methods: This was a cross-sectional observational study conducted in the PACU at the RCWMCH. A Paediatric Anaesthesia Handover Checklist was used to evaluate current handover practices. The checklist consisted of 26 mandatory items requiring verbal handover. Based on each item handed over, a score was calculated out of 26, and this was expressed as a percentage. Results: Fifty-five handovers were observed, involving 20 anaesthetists. The average duration of handover was 54.23 s. Handovers were frequently incomplete, with scores ranging from 0 out of 26 to 17 out of 26 (65.38%), and an average score of 5.54 out of 26 (21.31%). The most commonly handed-over item was intraoperative analgesia 42 out of 55 (76.36%). Despite routine administration, use of sedative premedication was reported in only 26 out of 55 (47.27%) of cases. Conclusion: The quality of handover in the PACU at the RCWMCH was low. Critical patient safety information was frequently omitted, highlighting the need for intervention. The use of checklists may improve the quality of communication and prevent potential adverse events. Contribution: This audit demonstrates significant gaps in paediatric PACU handover in a resource-limited setting and supports the introduction of a structured handover checklist as a low-cost intervention to improve communication and patient safety.