Highlight
- The SIPS system introduces a structured 4-step surgical handover protocol focusing on prioritization and clear communication.
- Implementation of SIPS improved handover quality and shortened the incidence of deteriorating patient vital signs at 12 and 24 hours post-handover.
- Staff-reported safety events related to handover decreased significantly, alongside improved staff perceptions of safety without increasing handover duration.
- The study demonstrated successful adoption, high fidelity, and sustainability of the system across two tertiary academic hospital surgical departments.
Study Background
Effective handover in surgery is critical to ensuring patient safety during transitions in care. Inadequate communication during patient handover has been linked to adverse events and impaired clinical outcomes, particularly in emergency general surgery where patient acuity is high. Despite well-recognized risks, a universally accepted criterion standard for surgical handover practices is lacking, resulting in variability and potential patient harm. This study addresses the unmet need for a standardized, evidence-based surgical handover framework designed to optimize patient physiology and safety.
Study Design
This prospective interventional cohort study incorporated an effectiveness-implementation hybrid design and was conducted between January 2023 and June 2024 at the general surgery departments of two tertiary academic hospitals. Physicians participating in post-call (emergency) handover meetings were enrolled. The intervention introduced was the SIPS system, a four-step protocol comprising:
- Sickest patients first
- Introduction, Situation, Background, Assessment, and Recommendation (ISBAR) communication
- Prioritize
- Summarize
Consecutive emergency general surgery patients with at least six hours of Early Warning Score data post-handover were analyzed before and after SIPS implementation. Primary outcomes included assessments of handover quality, patient physiological parameters, length of stay, mortality, escalations in care, and staff perceptions of safety. Data collection involved direct handover observations, retrospective patient record reviews, and staff surveys.
Key Findings
Data from 2261 patients were analyzed; 1469 pre-intervention (mean age 54.6 years, 48.2% female) and 792 post-intervention (mean age 52.8 years, 51.9% female). A total of 182 residents participated in 126 handover meetings observed over the study period.
Post-intervention, there was a statistically significant improvement in handover quality across multiple domains without lengthening handover meeting durations. The proportion of patients exhibiting improved vital signs at 12 hours post-handover increased from 16.8% to 21.5% (difference 4.6 percentage points; 95% CI, 1.2 to 8.1; P = .007) and at 24 hours from 20.0% to 26.8% (difference 6.7 percentage points; 95% CI, 3.0 to 10.4; P < .001).
Staff-reported handover-related patient safety events significantly decreased following SIPS implementation, from occurring on 19.7% of days before the intervention to 4.6% after (difference -15.1 percentage points; 95% CI, -4.5 to -25.6; P = .004). Additionally, staff reported higher perceptions of handover safety and quality.
The findings indicate robust adoption of the SIPS system with high fidelity to the handover protocol and sustainability demonstrated throughout the study period.
Expert Commentary
The study by Ryan et al. represents a pivotal advance in surgical safety by applying a structured communication framework to emergency general surgery handovers. The integration of the ISBAR tool within the prioritization strategy emphasizes clarity, completeness, and efficiency, which are critical in fast-paced surgical settings. This evidence aligns with existing literature advocating for structured handover tools such as SBAR in various clinical contexts but expands applicability specifically to surgical emergency care.
While the improvements in vital signs and reduced safety events are encouraging, the study did not demonstrate significant changes in length of hospital stay or mortality, suggesting physiological improvements may translate into more nuanced or longer-term outcomes requiring further follow-up.
Limitations include the single-country academic hospital settings which may affect generalizability to resource-limited or community environments. Additionally, the reliance on Early Warning Score data as a surrogate for physiology and safety, while pragmatic, may not capture all domains of patient risk after handover.
Future studies could explore integration with digital handover tools and examine patient-centered outcomes, including post-discharge metrics and qualitative staff feedback to refine implementation strategies.
Conclusion
This rigorously conducted study demonstrates that the SIPS surgical handover system enhances the quality of handover communication, improves early post-handover patient physiological status, and reduces handover-related safety events without increasing the time burden on clinical staff. Adoption of SIPS has the potential to standardize surgical handovers, thereby improving patient safety in emergency surgical care settings. Ongoing research to validate these findings across broader surgical disciplines and healthcare settings will be critical to establish the generalizability and long-term clinical impact of structured handover protocols.
Funding and Registration
The study was funded and conducted by the SURGical Improvement Network (SURGIN) collaboration. The trial design incorporated an effectiveness-implementation hybrid approach to facilitate both outcome assessment and real-world adoption. Further details on funding sources or clinical trial registration were not disclosed in the primary publication.
References
Ryan JM, Lynn TM, Kavanagh DO, et al. A Surgical Handover System for Patient Physiology and Safety. JAMA Netw Open. 2025;8(10):e2538896. doi:10.1001/jamanetworkopen.2025.38896.
