Perioperative Handoff Enhancement Opportunities Through Technology and Artificial Intelligence: A Narrative Review

Abstract

Background: Perioperative handoffs occur as patients progress through preoperative, intraoperative, and postoperative phases of care. These may occur between clinicians from the same or different role groups, between different care units, for brief breaks during the course of a surgery, or at shift or service changes. Perioperative handoffs occur during a period of increased vulnerability, as teams must convey critical information at a time of high cognitive load, with many potential distractions.

Methods: A search of MEDLINE was conducted for biomedical literature pertaining to perioperative handoffs and technology, electronic tools, and artificial intelligence. The reference lists of identified articles were reviewed, and additional citations were included if relevant. These articles were abstracted to summarize the current literature, and to frame the opportunity for enhanced opportunities to improve perioperative handoffs through technology and artificial intelligence.

Results: Several efforts to date have incorporated electronic tools to improve perioperative handoffs but have been limited by imprecision in selecting handoff elements, increased task burden for clinicians, interrupted workflows, physical barriers, and lack of institutional support for their implementation. At the same time, artificial intelligence (AI) and machine learning (ML) are being applied across healthcare, but their use in and integration into handoff workflows have not yet been studied. Use of existing technology including mobile applications, barcode scanners, and radio-frequency identification (RFID) tags to advance perioperative safety has only begun and similarly has not been applied to handoffs.

Conclusion: In this narrative review, we synthesize prior research on electronic tools for perioperative handoffs, limitations of current tools and barriers to their implementation, and the use of AI and ML in perioperative care. We then discuss potential opportunities to further integrate healthcare technologies and apply AI-derived solutions in the concept of a "smart handoff" with the aim of reducing harm from handoffs and improving patient safety.