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World Patient Safety Day 2025
Effective Handover: an important patient safety tool in paediatric surgical specialities

Miss Chloe Roy

MBChB MRCS RCSEd , Paediatric Surgery ST4

TriPS (Trainees in Paediatric Surgery) national representative

Effective Handover: an important patient safety tool in paediatric surgical specialities 

In paediatric surgery, our patients are not only vulnerable due to their age but also due to the complexity and acuity of their conditions. Continuity of care is, therefore, paramount. Among the various factors that influence outcomes, clinical handover is a key determinant of patient safety. In addition, improved handover practices are linked to shorter hospital stays, higher patient and carer satisfaction and staff satisfaction (1). 

This isn’t unique to paediatric surgical practice; it applies to all specialities. The increase in shift-pattern working for resident doctors makes robust handover crucial. There is also frequent transfer of on-call responsibility between senior residents and between consultants, making continuity of care very much a team responsibility (1). Here we highlight key aspects of handover in the Paediatric setting and discuss how we can optimise practice, with the aim of improving patient safety. 

Specific considerations in children undergoing surgery 

Our patients differ significantly from adults, not only in their physiology but also in how their conditions present and evolve. Factors of particular importance which should be considered during handovers include: 

  • Children have narrow physiological reserves and can deteriorate quickly, requiring clinicians to maintain a high index of suspicion.   

  • Many of our patients cannot effectively communicate their symptoms or advocate for themselves 

  • Surgical anatomy can be complex, especially in neonates or children with congenital anomalies 

  • Parental concerns and family dynamics play a major role in management decisions and social situations can be sensitive 

  • Medications and fluids must be tailored with narrow safety margins - taking age, weight and indication into account 

  • Care often involves coordination across multiple teams – medical and surgical, critical care, nursing, anaesthetics 

  • Tertiary referrals come from significant distances requiring close communication with other hospitals, transport teams and local bed management. Effective handover between these teams and between shifts while transfers are awaited is paramount to ensuring a safe patient journey.  

 

Ineffective handover can affect our small patients in big ways 

Communication failure during handovers is frequently identified as a contributing factor in root cause analysis for critical incidents (2). In paediatrics, the margin for error is minimal. Particularly considering the above, miscommunication can negatively impact patient safety in a number of ways which often interact: 

  • Delayed identification and management of clinical deterioration

  • Medication errors - missed or incorrect doses (the BNF is your best friend)

  • Delayed surgical interventions - e.g. incorrect NBM times (is the patient breast or formula-fed?, inadequate pre-op preparation or interdisciplinary communication

  • Duplication or missed investigations - unseen or unactioned results

  • Poor management of pain or fluid balance – pain can be difficult for children to convey, prescribing requires careful consideration of patient weight/size, fluid balance has small margins for error 

  • Breakdown in continuity of care between teams - across shifts or between wards and theatres (did the patient receive antibiotics / opiates / a fluid bolus?)

  • Breakdown in communication with patients, parents and families  

  

Optimising handover practices 

Recognising and addressing barriers to effective handover is essential for sustainable improvement. Key principles, many relevant to all specialities, include: 

  

  • Standardisation: Handover check-lists are one of the most commonly-reported successful patient-safety interventions in Paediatric Surgery literature (3). Structured tools (e.g. SBAR or I-PASS) can have significant benefit. Indeed, implementation of a structured handover model reduced medical errors by 23% and preventable adverse events by 30% in a prospective, multi-centre paediatric study (4).  The national PEWS (Paediatric Early Warning System) allows close monitoring of trends in observations according to age and includes parental concern. This succinct data aids handover of unwell patients (5). Many units include a safety briefing as a routine part of handover, highlighting specific items e.g. high-risk patients; similarly named patients; safeguarding concerns. This helps avoid critical details from being missed and aids situational awareness for the whole team (6). 

  • Interactive, timely communication: Time pressures are inevitable. We must strike a balance between comprehensiveness and efficiency. Handover should allow time for questions, clarification, and feedback, ensuring the receiver understands the patient's situation and plan.  

  • Accessible, open environment: Paediatric Surgery is inherently senior-led. However, it is vital that all staff feel empowered to contribute to handover and that open questioning is encouraged. 

  • Minimising interruptions: Protected handover time, free from clinical distractions, enhances focus and reduces the risk of omissions. Particularly when handover is opportunistic e.g. in the theatre coffee room between cases or in the busy admissions unit, we must be mindful of allocating focus. 

  • Written/electronic support: Documentation should be clear, structured and up-to-date in order to complement (not replace) verbal handovers, alongside patient records for cross-referencing.  

  • Consideration of high-risk scenarios: Step-down transfers from NICU or PICU, post-operative admissions, handover when patients are in transit (particularly neonates or unwell children). These are critical timepoints when effective transfer of information is vital. Specific factors to consider when handing over paediatric surgical patients are outlined in Figure 1. 

  

Remember ! Handover is not only between clinicians. Patient safety can be negatively impacted by the assumption that the relevant staff have received information. If a child’s nurse is not aware of a planned change in fluid regime, how can we expect it to occur? If the pharmacist doesn’t know we’re planning to start parenteral nutrition for a baby, how can we expect it to be dispensed?  

  

A powerful patient-safety tool 

Particularly in paediatric practice, the stakes of inadequate handover are too high to ignore. It is not merely an administrative task, but a critical clinical skill that directly affects patient outcomes. By considering both the generalisable and specific aspects of Paediatric Surgical practice discussed here, every handover can be a powerful opportunity to optimise patient-safety. 

 

References

 BMA. Safe Handover: safe patients. BMA Junior Doctors Committee, 2020.  

  1. Joint Commission (USA). Sentinel Event Data 2024 Annual Review. 2025, jointcommission.org 

  1. MacDonald. A, Sevdalis. N. Patient safety improvement interventions in children’s surgery: A systematic review. J Pediatr Surg (2017) Mar;52(3):504-511. doi:10.1016/j.jpedsurg.2016.09.0582017  

  1. Starmer AJ, et al. Changes in Medical Errors After Implementation of a Handoff Program. New Engl J Med (2014) 371(19):1803–12. DOI: 10.1056/NEJMsa1405556 

  1. Royal College of Paediatrics and Child Health. (2024). National PEWS Programme – Including the voice of carers. Available at: rcpch.ac.uk/work-we-do/paediatric-early-warning-system-pews 

  1. Royal College of Surgeons of England. Safe handover: guidance for the working time directive working party. RCSENG - Professional Standards and Regulation 2007. Available at: rcseng.ac.uk/library-and-publications/rcs-publications/docs/safe-handover/