Systematic review of OR to ICU handoff standardization interventions highlights need for focus on sustainability and patient outcomes

Abstract Background: Operating room (OR) to the intensive care unit (ICU) handoff standardization is a well-studied intervention to decrease preventable patient harm. We conducted a systematic review to synthesize findings about OR to ICU handoff intervention sustainability and the impact on handoff interventions on patient outcomes, neither of which are well described in recent reviews of OR to ICU handoff studies.Methods: Inclusion criteria included full papers (i.e., not abstracts) describing original research with intervention descriptions. There were no exclusion criteria. We searched 10 electronic bibliographic databases (including PubMed, Scopus, and eight others) for studies published between 1995 and October 2021 describing OR to ICU handoffs. We used the Cochrane Consumers and Communication Review Group Study Quality Guide to present and synthesize results using the criteria pertaining to the study format and PRISMA guidelines for reporting.Results: Our search yielded 41 papers published between 2007-2021. Thirteen (31.7%) of the studies described a sustainability period following the initial implementation phase that lasted 3-96 months. All studies with a sustainability period showed continued improvement of at least one study outcome. Nine studies measured patient outcomes, including unplanned or early extubations, delayed dosing of antibiotics, unspecified post-surgical complications, ICU-level patient mortality, among others. Of these, 7 (77.8%) reported statistical significance improvement of patient outcomes, but none were able to establish causation. Two studies reported no difference in any patient outcomes.Discussion: Interpretation of the evidence was limited by the risk of recall bias, Hawthorne effect, sampling bias, response bias, and no blinding of participants or personnel. Collectively, the evidence from all the studies examined is subject to both publication and selective reporting within studies. Overall, the studies demonstrate improvement in information exchange and clinician satisfaction with standardization but have not shown to cause improvement in patient outcomes. Only a few of these studies have focused on the sustainability of handoff standardization conventions. Overall, the field is heavily dominated by cardiac research and is lacking in sustainability research and patient outcome-correlated research.Other: Funding: The primary source of funding for this review was institutional funds.Register name: INPLASYRegister number: INPLASY202220035