Improving Compliance With Royal College of Surgeons Handover Standards: A Prospective Clinical Audit and Quality Improvement Project

Background: Effective handover of clinical information is essential to patient safety, particularly in surgical specialties where care is delivered across shift patterns.We undertook a prospective, closed-loop clinical audit and quality improvement project with the primary objective of determining whether a structured handover intervention improved compliance with Royal College of Surgeons (RCS) of England minimum handover standards.Secondary objectives were to characterise handover practices and information-transfer vulnerabilities across daytime intra-specialty urology handover and overnight inter-specialty cross-cover to general surgery, and to evaluate the uptake and impact of the resulting intervention.Methodology: Handover practice in a single urology department (Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust) was audited against six RCS of England minimum data criteria (patient name and age, date of admission, ward location, responsible consultant, current diagnosis, and results of significant or pending investigations), each scored out of six.Cycle 1 evaluated 12 handovers between March 15 and April 15, 2025.As urology inpatients are covered overnight by general surgery on-call Foundation Year 1 (FY1) doctors rather than urology-specific junior staff, a cross-sectional survey of 10 FY1s was undertaken, alongside assessment of the timing of overnight-to-day registrar handover.Findings were presented at the local audit meeting and informed a quality improvement intervention comprising an updated written handover template, a colour-coded patient stratification tool, a 07:30 deadline for flagging new patients prior to the daytime handover, and induction teaching for incoming FY1 doctors.Cycle 2 (reaudit) repeated the same assessment over 12 handovers (July 10-August 10, 2025); a combined cohort of 280 patient handovers was assessed across both cycles.Daily mean scores were compared between cycles using a paired-samples t-test.Results: The mean handover score improved from 4.39/6 (73.2%) in cycle 1 to 5.37/6 (89.5%) in cycle 2, a statistically significant increase (mean difference 0.98 points, 95% CI 0.64-1.31;paired t(11) = 6.38, p < 0.0001; Cohen's d = 1.84).The greatest gains were in documentation of the responsible consultant surgeon (49.2% (58/118) to 79.2% (133/168)) and communication of significant or pending investigation results (71.2% (84/118) to 95.8% (161/168)); 75 pending investigations, predominantly imaging, had been undocumented at cycle 1.Night registrar-to-day handover time improved from a mean of 07:37 to 07:15.Despite introduction of a colour-coded handover stratification tool, day-to-night handover remained purely verbal with no written record in either cycle, and on-call FY1s continued to report feeling inadequately prepared to assess deteriorating urology patients overnight.Conclusions: A standardised written handover proforma and an earlier registrar handover time produced a statistically significant, clinically meaningful improvement in compliance with RCS of England handover standards in a busy urology department.Day-to-night handover to on-call foundation doctors remained unstructured in practice despite a dedicated stratification tool, suggesting possible implementation barriers rather than a flaw in intervention design, although the specific reasons for non-adoption were not formally investigated; a third audit cycle assessing uptake of this tool is recommended.